Breast Cancer Screening Controversy

[Shisho]

Is anyone else kind of pissed off by this?

http://www.nytimes.com/2009/11/17/he...cancer.html?em

I understand that I may have a knee-jerk reaction to this, having just lost someone close to me to breast cancer in July. She was 52, and was diagnosed 2 years previous. Yes, I know that still puts her in the over 50 category, but it still cuts it a bit close to me. She told me before she died how important self-screening was, and how she wished she had known enough to check the far edge of her breast just under her armpit, which is where the cancer originated. So yeah, I'm kind of angry at this, but I might not be thinking clearly. It just sounds to me like this task force is saying "yeah, that 15% of women who didn't die because of early detection? Not important. They cost too much money."

Am I missing something? Are these people really saying that you shouldn't check yourself because it might stress you out a little bit? And how stressed out would a woman be to NOT check and have the cancer spread? Pretty damn stressed out, I'd say. And why wasn't an oncologist on that panel?

I guess it's one thing if the billions of dollars they say would be saved with the new guidelines actually went into cancer research, but I'm not sure who is benefiting from all that saved money. If it's just insurance companies, I say fuck 'em and get your boobies checked.

Anyone want to weigh in? I know we have a few YABSers in the medical profession. I'd love to hear what you have to say about this.

Other links:
http://www.nytimes.com/2009/11/18/he...octors.html?em

http://wellness.blogs.time.com/2009/...rss-topstories

[scout1279]

I'm in complete agreement with you, especially as someone who knows several people who have had masectomies under the age of 50.

[Kosmopolit]

"It just sounds to me like this task force is saying "yeah, that 15% of women who didn't die because of early detection? Not important. They cost too much money.""

No, they're saying those 10% of women who got false positives and ended up going through years of fear, chemotherapy and mastectomies unnecessarily so their doctors and the medical scanning companies could make money off them are being exploited and it has to stop.

And I'm not sure we're you're getting that 15% figure from.

[Shisho]

Originally Posted by Kosmopolit

"It just sounds to me like this task force is saying "yeah, that 15% of women who didn't die because of early detection? Not important. They cost too much money.""

No, they're saying those 10% of women who got false positives and ended up going through years of fear, chemotherapy and mastectomies unnecessarily so their doctors and the medical scanning companies could make money off them are being exploited and it has to stop.

And I'm not sure we're you're getting that 15% figure from.

From the actual article:

Over all, the report says, the modest benefit of mammograms — reducing the breast cancer death rate by 15 percent — must be weighed against the harms. And those harms loom larger for women in their 40s, who are 60 percent more likely to experience them than women 50 and older but are less likely to have breast cancer, skewing the risk-benefit equation. The task force concluded that one cancer death is prevented for every 1,904 women age 40 to 49 who are screened for 10 years, compared with one death for every 1,339 women age 50 to 59, and one death for every 377 women age 60 to 69.

And the article isn't talking about women getting chemotherapy or mastectomies when they don't have cancer. I'm not sure where you got that information from. Again, according to the article:

While many women do not think a screening test can be harmful, medical experts say the risks are real. A test can trigger unnecessary further tests, like biopsies, that can create extreme anxiety. And mammograms can find cancers that grow so slowly that they never would be noticed in a woman’s lifetime, resulting in unnecessary treatment.

[sk716]

I have an even worse knee jerk reaction to it. A couple of years ago a friend and co-worker, who was 32 at the time noticed a lump in the shower one morning. She went to her GP and asked to be referred for a mammogram. He refused telling her she was too young to have breast cancer. She called another doctor.

It was in fact breast cancer. It had metastasized. The chemo gave her a form of chemical induced leukemia.

But, no, she was 32, she couldn't possibly have had breast cancer and didn't need a mammogram.

She's doing better now. Her hair has grown back but she still has regular treatments.

If you have breasts, do a self exam often, if you find a lump find a doctor who will schedule you for a mammogram.

[Kosmopolit]

The USPSTF found fair evidence that women who have screening mammography die of breast cancer less frequently than women who do not have it, but the benefits minus harms are small for women aged 40 to 49 years. Benefits increase as women age and their risk for breast cancer increases. However, there are relatively few studies of mammography for women aged 75 years or older. The potential harms of mammography include anxiety, procedures, and costs due to false-positive results and receiving a diagnosis and treatment of cancer that never would have surfaced on its own within a woman's natural life time. They found that the benefit of mammography every 2 years is nearly the same as that of doing it every year, but the harms are likely to be half as common.

http://www.annals.org/content/151/10/I-44.full

Oh and most women who develop breast cancer before age fifty have a family history of breast cancer or other indicators of heightened risk - and the guidelines still recommend that those women get mammograms.

The idea that this is being doen to save money not only requires that the doctors on the panel are monsters it also requires that they be imbeciles - seeing as late stage breast cancer costs far mroe to treat.

I'm sorry for people who've experienced breast cancer or who have friends who have experienced it - but that fact by itself does not qualify you to make medical judgments about the relative risks of different procedures.

Besides who decided once a year from age forty is the approrpriate standard?

Why not every month from age 15 onwards?

The more the merrier, right?

[Charles RB]

Worrying about unnecessary treatment (because cancer treatment can whack your health) and anxiety, fine, good thing.

But unless as many or more women die as a result of this than are saved by the screening, then I don't see the point in worrying more about it than about breast cancer.

[Kosmopolit]

One woman in 2,000 who gets a mammogram is diagnosed with breast cancer as a result.

That includes the false positive results.

False positives are pretty much by definition most likely to occur in the women with the lowest actual risk - i.e. women under fifty.

[Village Idiot]

The mammogram may soon go the way of the dodo. There is a better testing method involving scanning for newly created blood vessels. Cancer tumors, no matter how small, need blood to grow, and most grow their own blood vessels. It is an infrared scan.

[Village Idiot]

Originally Posted by sk716

If you have breasts, do a self exam often, if you find a lump find a doctor who will schedule you for a mammogram.

And if you have testicles, you should be doing a regular self-exam.

[the4thpip]

I had a colleague who got one of those false positive results.

She had a nervous breakdown, lost her job and still suffers from burn out.

[Shisho]

Originally Posted by Kosmopolit

The USPSTF found fair evidence that women who have screening mammography die of breast cancer less frequently than women who do not have it, but the benefits minus harms are small for women aged 40 to 49 years. Benefits increase as women age and their risk for breast cancer increases. However, there are relatively few studies of mammography for women aged 75 years or older. The potential harms of mammography include anxiety, procedures, and costs due to false-positive results and receiving a diagnosis and treatment of cancer that never would have surfaced on its own within a woman's natural life time. They found that the benefit of mammography every 2 years is nearly the same as that of doing it every year, but the harms are likely to be half as common.

http://www.annals.org/content/151/10/I-44.full

The idea that this is being doen to save money not only requires that the doctors on the panel are monsters it also requires that they be imbeciles - seeing as late stage breast cancer costs far mroe to treat.

I'm sorry for people who've experienced breast cancer or who have friends who have experienced it - but that fact by itself does not qualify you to make medical judgments about the relative risks of different procedures.

Oh dear. I have a feeling you think my anger is politically motivated, which it isn't. I could care less if Republicans are saying this is all a Democratic conspiracy to reform healthcare or if Democrats are saying "this is why we need to reform..." blah blah blah blah. I may be wrong, but given your posts in other threads, that's a guess. No. I don't think there are evil men smoking cigars somewhere twirling their mustaches and saying "mwa ha ha ha! This is how we'll milk the American public!" I don't think that's the case. However, since you asked, I do, often, question some of the medical procedures covered and not covered by insurance companies. For example, why would they deny coverage of birth control drugs and/or procedures (vasectomies, etc.) when having a baby is so much more expensive? Why would they deny coverage of smoking-cessation drugs when lung cancer and cigarette-related illnesses are so much more expensive to treat? I will be honest with you: I really don't know. But the "it would be more expensive to treat late-stage breast cancer" argument doesn't hold much water when compared to that. There may be factors I'm not aware of, but the fact is, on the surface, for someone not in the insurance field, it's something that doesn't seem to make much sense, but is. I suspect, like everything, it has something to do with money. I just don't know.

Here's why I'm angry. My anger is at the implications of this task force recommendation, and my anger is at insurance companies. Not red or blue, but specifically insurance companies because I, personally, have had too many dealings with them to not have my judgement colored somewhat. (But that's not a story for the here and now.) I'm annoyed because I am afraid insurance companies will point at this and say "this study says I don't have to pay for your mammogram because you are under 50." If you don't think that is a real concern, that you are lucky because you probably have never had an insurance company override your doctor's recommendation at your treatment. Good for you. I have. It is a real concern.

Mammograms are expensive, and it seems like they are making this recommendation because some women get stressed out at the need of a biopsy, which is understandable. Now, I'd like to see a chart, if there is one, of the percentage of women who have received severe treatments related to false positives, and compare that to the 15% of women who could have been saved because of early detection. I'm sure there is one, I'm not being snarky or superior in the slightest. If you can show that to me, and if it is significant, I will rethink my position. I'm not above rethinking something if a logical argument can be presented to me.

Oh and most women who develop breast cancer before age fifty have a family history of breast cancer or other indicators of heightened risk - and the guidelines still recommend that those women get mammograms.

Yes, I am aware. I read the article(s) too. We are talking outside the normal high-risk women here.

Besides who decided once a year from age forty is the approrpriate standard?

Why not every month from age 15 onwards?

The more the merrier, right?

Your sarcasm is noted. Since you provided the link, let's use the report you linked to:

www.annals.org

Who decided once a year from age forty is the apprropriate standard? The American Medical Association, the American Cancer Society (a group which is sticking by its original recommendations despite what this task force recommends), and the National Comprehensive Cancer Network as recently as this year. Now, if you want to get specific, I actually prefer the recommendation of The American College of Physicians over the USPSTF task force. Their position is that "the decisions in women aged 40 to 49 years should be based on individualized assessment of risk for breast cancer..." That, I think, would have been more responsible than simply denying that mammograms across the board for women under 50 (not including those high risk cases with history, etc.) are "worth it." When faced with what the task force recommends, it seems that many doctors are giving all of the information, who does and who does not. That I can respect.

Originally Posted by Village Idiot

The mammogram may soon go the way of the dodo. There is a better testing method involving scanning for newly created blood vessels. Cancer tumors, no matter how small, need blood to grow, and most grow their own blood vessels. It is an infrared scan.

That is actually good news, as mammograms aren't exactly fun. I'll have to look into that. Thanks!

[Kosmopolit]

Originally Posted by the4thpip

I had a colleague who got one of those false positive results.

She had a nervous breakdown, lost her job and still suffers from burn out.

Yes but think of the hypothetical 0.1 of a woman who was saved from dying of actual cancer.

[sk716]

Originally Posted by Village Idiot

And if you have testicles, you should be doing a regular self-exam.

This is true. Testicular cancer is just as serious and deadly as breast cancer, but nobody ever wants to discuss saving the testicles. Breasts are just more ascetically pleasing.

[Shisho]

Originally Posted by sk716

This is true. Testicular cancer is just as serious and deadly as breast cancer, but nobody ever wants to discuss saving the testicles. Breasts are just more ascetically pleasing.

Think of the stickers for that campaign! Blue ribbons everywhere! "Play with your balls!"

...I may not have had enough coffee.