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Now that the dust has settled on the mammogram issue, I’ve had time to digest all of the news. In as much as I am from 3 generations of breast cancer survivors and carry the BRCA2 gene, I may be too biased to see any other perspective other than the pro-early detection side of the mammogram debate BUT I’m not too biased to be confused by the conflicting reporting of the last week. The new recommended standard of not having mammograms until the age of 50 (and then every two years) and the report that discourages doctors from teaching self-examination techniques are so foreign to how I’ve managed my own breast cancer threat as well as the other women in my family affected by breast cancer. Three out of the 5 women who had breast cancer were diagnosed years before their 40th birthday and self exam saved my Mother’s life so without early detection, mammograms and breast self-examinations, I would have to re-write my family history to say I’m from 3 generations of breast cancer victims.
The reason for the new recommended standards, according to the task force (USPSTF), is that studies show that “the additional benefit gained by starting screening at age 40 years rather than at age 50 years is small, and that moderate harms from screening remain at any age.” They also cite the potential harms of screening as anxiety, extra procedures and costs due to false-positive results. Anxiety should not have a bearing on whether women ages 40-49 are screened. I’ve experienced a false positive MRI breast cancer screening however the anxiety was a minor concern. I needed to know whether I had breast cancer which required an extra procedure. Furthermore, switching ‘recommendation gears’ so suddenly must also be considered anxiety producing! So what is the USPSTF referring to when they say “additional benefit” is small? They apparently are referring to the 1 in 2000 women who were screened (ages 40-50?) and were fortunate enough to discover their breast cancer through mammograms or other diagnostic testing. That number may seem insignificant unless that ‘one’ number is your mother, sister, daughter, partner or someone else you love. Are we to become just a number in a statistical model, a cost that outweighs a benefit in a cost/benefit ratio? I guess it depends on your perspective. Let’s face it, our perspectives can and do change based upon what life throws our way!
I guess what I’m saying here is that these are subjective questions and I’m afraid the answers are just as subjective, which raises another question - who is the United States Preventive Services Task Force? According to the U.S. Dept of Health and Human Services website, the “USPSTF” is “an independent panel of experts in primary care and prevention.” The mission of the USPSTF is to “evaluate the benefits of individual services based on age, gender, and risk factors for disease; make recommendations about which preventive services should be incorporated routinely into primary medical care and for which populations; and identify a research agenda for clinical preventive care.” According to the U.S. Dept of Health & Human Service, the panel consists of a group of professionals, almost all of them being either academic medical professors or medical professionals. If you want to see who exactly are the current members of the USPSTF, you can view the entire list on the US Department of Health & Human Services web site. Apparently this panel was appointed during the Bush administration. The creation of the task force dates back to 1984, at a time when screening methods for cancer, cholesterol levels and diabetes were just emerging and rarely paid for by insurers. Dr. J. Michael McGinnis, deputy assistant secretary for health, decided to set up a group to evaluate how well such methods worked. McGinnis wanted the group to be insulated from politics and choose a panel that could objectively evaluate evidence. He wanted to avoid this group being exposed to political pressure. Although appointed by the Department of Health and Human Services, the group works at arms length and makes decisions without consulting the agency. This seems to be the case in as much as the current Secretary (Kathleen Sebelius) has publicly distanced herself from the panel’s recommendations by saying “mammograms have always been an important lifesaving tool in the fight against breast cancer and they still are today. Keep doing what you have been doing for years - talk to your doctor about your
