To screen, or not to screen?
I have been trying, this week, to understand the significance of the new guidelines for breast cancer screening.
As near as I can figure, the new recommendations are that women in their 40s not get mammograms, and that all women should stop doing self-exams. Stories and interviews about this have been all over the newspapers and the radio, and they are not terribly helpful because of the determinedly balanced method of reporting: Here's a person saying why the new guidelines are good. Here's a person saying why the new guidelines are not good. And we, women with breasts that either should or should not be screened, are stuck in the middle, heads swiveling.
The reasons for not screening (or doing a self-exam) appear to be:
1.) Too many false positives
2.) False positives lead to unnecessary procedures--biopsies, even mastectomies.
3.) False positives cause women agitation. (This reason keeps coming up, and I find it so patronizing I can barely contain myself.)
4.) Even correct positives are generally found so late that the cancer has been growing for years already and it's basically too late to do much. Mammograms do not prevent mortality. (But nothing, of course, can prevent mortality.)
That last point, Number 4, was the subject of a brief interview on "All Things Considered" the other night, and I could not believe what I was hearing. The speaker, a San Francisco doctor, did not explain how he thought these cancers would be found, if not by mammogram or self-exam. He seemed to think the whole thing was futile and it's just best not to know if you have a lump because no matter what, it's almost always too late. Surely that's not what he meant. Surely.
The interviewer did not ask the logical follow-up questions. I can only guess that she was as astounded as I was by what she was hearing.
For clarity, all I can do is look at my life, and at the people around me. At work, several women have recently discovered breast cancers. They have very quietly gotten treatment, returned to work, returned to health. It's not routine, but they make it seem so. I haven't asked them how they found their cancers, but I assume it was either through a mammogram or a self-exam. What other way is there?
Let's be even more specific. Let's use my family as a case study.
My sister Kristin was one who had many false positives over the years. She had dense, fibroidy breasts, and mammograms often showed shadows that turned out to be cysts. So she stopped having mammograms. When yet another lump showed up, she ignored it. Ah, but this one was cancerous. She steadfastly ignored it until the cancer had not only metastasized to her lymph nodes, but had invaded her bones, as well. She was finally diagnosed with stage four breast cancer at age 47 when a cancerous rib snapped. She lived six more years. Mortality was not prevented.So that's what can happen when you don't do self exams or mammograms, I guess.
My sister-in-law Cynthia, on the other hand, discovered a lump during a self-exam. She, too, was in her 40s. She went to the doctor, endured the arduous treatment, and now, four years later, is perfectly fine.But according to the new standards, at least as I understand them, Kristin did things right and Cynthia did things wrong. It seems pretty cut and dried to me that that is exactly the opposite of the truth. But I must be missing something. What am I not understanding?






























































