Cancer Screening Guidelines Are Difficult To Accept
I recently met Stephanie Spielman, a wife, mother and breast cancer patient, who was battling cancer for the fifth time. She was very frail, with a warm smile and what could best be described as a peach fuzz-like mullet where her hair was just starting to grow again.
Ironically, we met during Breast Cancer Awareness Month.
I thought of Stephanie and so many others last week, when the U.S. Preventive Services Task Force announced its revamped mammography guidelines.
Among their recommendations: Most women in their 40s do not need routine screening, and in their 50s, a mammogram every other year is sufficient. Why? Because in women aged 40-49, for every 1,900 women screened, only one cancer death is prevented in a procedure that yields a high rate of false positives — results that would necessitate further tests and possibly surgery.
That number was 1 in 1,300 for women 50 and older.
The task force said it was also trying to alleviate the anxiety of a false positive.
How about the really horrible anxiety of finding a late-stage breast cancer, one that could have been detected earlier and with better prognosis on a mammogram?
The task force said these recommendations are for women of "average risk," not for women like me.
See, my mother and father both had breast cancer. That, coupled with multiple biopsies and my own breast disease, ultimately led me to choose a preventive mastectomy in 2007.
Family history is a big risk factor, but it only counts for about 10 to 15 percent of breast cancer cases. The rest come out of the blue, in women of "average risk."
So that's why I cannot fathom telling doctors not to teach women how to self-examine their breasts, which is exactly what the task force did. Aren't we supposed to know our own bodies — what looks wrong, feels wrong? We're supposed to know our cholesterol number, our blood pressure reading. Why would we not want to know what our breasts feel like?
A breast self-exam is free, it's easy — and what's the harm? Tell women like Stephanie, who found her lump in the shower, that it's pointless. She was 30 years old and pregnant at the time.
The task force's recommendations have been almost universally decried. Health and Human Services Secretary Kathleen Sebelius advised women to keep doing what they are doing, as did Susan G. Komen for the Cure and the American Cancer Society.
As always — and this hasn't changed — know your personal risk. Talk to your doctor. And if she or he won't listen, find someone who will.
Stephanie Spielman died last Thursday, leaving her husband and four children heartbroken. The task force and its probabilities be damned.
Another breast cancer death is simply one too many.
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