The Mammogram Guideline Kerfuffle
Yes. So, who wasn’t surprised earlier this week, when we here in the US first heard about the U.S. Preventive Services Task Force’s reversal on yearly mammograms and monthly self-exams?
Things I believe:
• This report did not have appropriate PR in place when it was released (especially because it reversed long-held recommendations).
• The usefulness of self-exams has been overplayed by the medical community.
• I believe in the ability of science to review information with an unemotional eye.
• I have not heard that breast cancer deaths are significantly higher in Europe and Canada; and I know that British guidelines are for less frequent mammograms, starting later.
• New, similar, recommendations have recently been made for prostate cancer, so it is not surprising that a fresh look resulted in such changes to mammogram guidelines.
• The idea of cancer terrifies most, if not all, of us, and our first instinct is to attack it with the most aggressive measures possible.
• We take the effects of accumulated radiation much too lightly in our society (and I think back to how much radiation I was dosed with last year, and I think: how naive my post was!).
I do not believe:
• …that this is a ploy to disenfranchise women during an economic downturn (this is when I stopped listening to the radio show, when they let a caller say this — these reports take a long time to put together, so for liberal and fair NPR to allow such fear-mongering was irresponsible).
• …that because currently doctors do not take the time to sit and discuss personalized risk factors with patients, we should just continue to dose millions of women with extraneous radiation (a reason for continuing yearly mammograms that Dr. Weiss used in the radio conversation).
• …that the reasoning behind stopping self exams has convinced me yet (sure, they may not make a big difference if you are going in for mammograms every year, but if we push those back to every two years, they may play a more useful role).
Sadly, the chair of the Task Force, Dr. Calonge, is not a great speaker (clearly a researcher with little bedside manner) and the statistician who supervised the data crunching, Dr. Miglioretti, sounded terrified to be speaking on air. And sadly, Dr. Weiss was much too invested in this personally to come across as anything but a fearmongering reactionary.
What most people seem to overlook is that these are recommendations, not dicta in a one-size-fits-all command. If a woman has family history of breast cancer, if she works in a high-risk field or has had high exposure to unhealthy levels of radiation, or if she has had questionable scans in the past, then of course she may choose to continue with yearly mammograms (remember the x-ray issue though — a lump may be the devil you see, but radiation is certainly a devil we don’t see).
I had my first mammogram last fall, and had just last week received a letter reminding me to schedule my yearly mammogram. But if you recall, they had me redo one side — five times. I felt lots of anxiety about the whole situation, and even after I was given the “all clear” it still made me feel like I had dodged a bullet.
Because I have no other risk factors, and because I am young, I have chosen to sit back and wait for the time being, see how all this falls out — but make a concerted effort to remember my self-exams.
What have you or the women in your life elected to do at this time?