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Nov 19 2009

American boobs used as political football, part 472

Regular readers know that, news-wise, CNN confuses me, and that I have all but kicked the NPR habit (it seems fantastic, but El Rancho Deluxe gets only one radio station, and it only plays one song: that Red Hot Chili Peppers slow dance where the dude yodels in that weird accent about how he doesn’t ever wanna feel like he did that day), with the happy result that pop culture’s gnarly substrate — urgently breaking news — rarely filters down to the lab here at Spinster HQ until a week or two after everyone else has moved on to the next closeted gay Republican outing. This programming suits me and my eccentric recluse lifestyle perfectly. Seriously, must I know about every deranged serial killer’s murderous rampage? One deranged serial killer is very like another. Once a person has apprehended that serial killers serially kill, the philosophical implications may be considered grasped; reviewing a continuous stream evidence of the phenomenon is not only unnecessary, it’s prurient.

But, out of the loop though I be, even I have heard about this no-mammograms-until-you’re-fifty malarkey, and it probably won’t blow your lobe to hear that it blew my lobe. The report made particularly gikky reading in view of the recent Stupak craptacity. America just feels like taking a big old televised crap on women’s basic health care this week, I guess. If, after reviewing the stunning and sweeping misogynist antics our government has pulled over the past couple of weeks, a person could stand up and announce with a straight face that patriarchy doesn’t exist, he’d have to be a complete imbecile.

I allude to the absurd recommendations, released Monday by the U.S. Preventative Services Task Force, concerning the age at which women should begin queuing up at the old mammogram machine. They used to say 40. But now they say 50, and only every other year.

Check this out: the “harms outweigh the benefits.” Not just for under-fifty mammograms, but for over 75 mammograms, and — this one really kills me — breast self-examinations!

Wha?

That’s right, the U.S. Preventative Services Task Force says women shouldn’t be taught to touch their own boobs. The harm outweighs the benefits!

The dreadful harm from which they seek to protect us?

Anxiety.

Anxiety is bad for ladies. Worse, apparently, than blowing off the timely diagnosis of life-threatening illness.

Anxiety! Are they fucking kidding me? Does the U.S. Preventative Services Task Force think women pass their days carefree, lounging on puffy clouds of pink velvet laundry eating Boston cream pie-flavored Yoplait? For fuck’s sake, I don’t know a single woman whose lobes aren’t fucking soaking in anxiety just as a matter of course. I slurp down a couple of Ativans every morning with my Bloody Mary or I can’t leave the house. Anxiety is pie for women. It’s death that tends to slow us down a little.

Here’s an anecdote. One time I came down with breast cancer myself. I had the impertinence to come down with it at the age of 46. How did I know I had cancer? I happened to be giving myself one of those harmful self-exams and found a tumor the size of Guam up in that mug, that’s how. Did I subsequently experience anxiety? Hell yeah, I did. Do I prefer anxiety to death? Hell yeah, I do.

Of course, nobody really gives a crap whether women suffer anxiety. That’s just a lot of smoke up your ass. If they did give a crap, they’d make rape illegal or something. What they’re really so concerned about is that mammography can have false positives, which means expensive biopsies that insurance doesn’t want to pay for. But for crying out loud. Wouldn’t you rather have a biopsy that turned out to be unnecessary, than not have a biopsy that turned out to be necessary?

If I’d followed the U.S. Preventative Services Task Force Recommendations, I would be dead. Dead, dead, dead. As it was, I was pretty fucking sick.

So I’d like to shove my entire 46-year-old malignant tumor up the U.S Preventative Services Task Force’s entire ass.

Note: mammography is stunningly imperfect. It’s only useful in detecting cancer that’s already there. Which is to say, it’s a cure-based tactic. This makes it vastly inferior to preventative measures — vaccines, elimination of environmental carcinogens, etc — that might preclude cancer in the first place. Also, mammography is, as are all cure-based measures, useless for women who can’t afford subsequent treatment.

You know what else? Everyone should have access to free genetic testing to determine whether they have the breast cancer mutation. If you’ve got the mutation, your chances of tumoring out before age 50 are, like, 80%. Currently that test costs like 4 grand, and good luck getting your insurance company to cough up for it.

92 comments

2 pings

  1. nails

    I blogged about the ‘harm outweighs the benefits’ thing awhile ago. The reason it outweighs the benefits is because there is not any increase in survival when we screen like mad. What happens is that surgery and chemo is performed on people without any apparent benefit. They are going to do this for prostate cancer too actually; the UK does not do the crazy PSA screening for every dude thing that we do here but people don’t die more there.

    There is still reason to blame the patriarchy, however. Schools do not give most people the tools to actually understand their own health or how medical care works on even the most basic level, so this kind of guideline making is done on their behalf.

    Here is the important bit for anyone who doesn’t want to read my blog:

    They describe a synthesis of published papers that quantify the benefits and harms of screening using absolute rather than relative numbers that make it easier to comprehend. They conclude as follows: if 2,000 women are screened regularly for ten years, one will benefit from the screening, as she will avoid dying from breast cancer. At the same time, ten healthy women will, as a consequence, become “cancer patients” and will be treated unnecessarily. While there is debate about exactly what these numbers are (some data shows more women benefit and fewer healthy women treated unnecessarily) the overall picture is clear.

  2. Esteleth

    Oh yes, yes, yes!
    I am (prepare to be blown away!) both a woman and a scientist. Mysteriously, my uterus does not impede my ability to think!
    The new guidelines are based on sound science, but they are expressed in a truly stupid (and woman unfriendly) way. The logic – that most breast cancers form after age 50 – is good (yes, of course there are women who get it younger, including some of my own relatives). Also, as a woman ages, her breasts change in ways that make mammography more practical, less unpleasant, and less prone to giving false positives or false negatives. Okay, fine, all well and good.
    You know what the standards could have said?
    “Hey, ladies! Unless you are of high risk (defined has having relatives with breast cancer, having the BRCA1 mutation, having been exposed to nasty stuff, et cetera), until you’re 50, hold off on doing annual mammograms. Keep inspecting yourself to see that you’re healthy and seek help if you suspect something’s wrong, but don’t worry too hard – most cancers will show up after 50. Also, there doesn’t seem to be a lot of good in doing one every year. Unless you’re of high risk, back down to one every other year.”
    Instead, they said this:
    “Fear the boobies! Don’t touch yourself! Don’t learn your risks! Wait to find out too late that you have breast cancer!”
    This is ass-backwards in a way that is truly lobe-blowing.
    If they really wanted to bring down the breast cancer rate, then the steps are pretty simple:
    1. Educate! Teach women about their own bodies!
    2. Develop vaccines, genetic tests, and effective screens that work before the tumor is big enough to be seen in mammography! Then, make the tests and vaccines cheap enough for women to actually access!
    3. Seriously think about the environmental stuff that may be increasing risks!
    But, of course, we can’t do that, ’cause women’s bodies are icky. Or something.

  3. agasaya

    http://www.medscape.com/viewarticle/701881?src=mp&spon=42&uac=19444SJ

    Yes, the idiocy continues as with the above link dissing breast self-exams. I love this guy comparing it to self-examination of testicles. My bet is that he examines his testicles more than just annually. And that any scrutiny which would help keep them intact would be considered necessary.

    This moron also suggests women will blame themselves if they miss catching a mass. Sure, I’d MUCH rather blame a doctor for not catching it on the say, once in three years I actually get such an exam performed by an ‘expert’. By the time a real doctor found a tumor in me, it would be during an autopsy. And if they don’t do any exams, EVERY woman can feel stupid for missing the chance to identify one early.

    My other favorite moment in that article (there are so many) is the idea that self exams lead to excessive numbers of biopsies. I didn’t know we could perform them ourselves. I though a real doctor had to review the problem and decide all on his/her own to do one or not. So, self-exams (which are screenings or tests designed to ensure false positives) lead doctors to make bad decisions. Impressive. We’ll have to stop it immediately for their sakes.

    The real deal here is that their studies indicated insignificant changes in mortality rates for those doing self-exams. So, if you find something, please have the decency to live and wreck their statistics just like Jill.

    Below is a better summary which also points to research I’ve seen showing that self examinations are just as accurate or better than any other test for detecting occurrences or recurrences of masses in high risk women. Likely because the exam is done properly!

    http://www.webmd.com/breast-cancer/news/20090422/new-view-in-debate-on-breast-self-exams

  4. blucas!

    When I read the title of this post I was sure it was going to be about Sarah Palin. I’m not sure if conservative reaction to her or liberal dude reaction to her is more squicky.

    But yeah, this is definitely part of a larger shift away from an emphasis on early detection (they’re doing the same with prostate cancer screening and colon cancer screening).

    As nails points out, the dirty secret is that it’s not that detecting cancer early increases the likelihood of harmful outcomes, it’s that getting you into the “best medical system in the world” early increases the likelihood of harmful outcomes.

  5. yttik

    Thank you, Twisty.

    There are other reasons to exam one’s breasts, pregnancy, hormonal changes, skin cancer, infection. Breasts are a part of a person’s whole body, a part of over all health. Breasts don’t exist in suspended animation, separate from the people they are attached to, as we have been led to believe. I can see no valid reason for suggesting women stop learning how to examine their breasts, except misogyny and an unwillingness to spend money on women’s health issues.

  6. Belle O'Cosity

    I was once the personal assistant to a very rich couple who were big deal members of the republican party. I had been working for them for a month when while driving with the woman she started to ask me about my family. I told her that my mother had died of breast cancer (actually complications due to the treatment of cancer). She responded that I should make sure that I get a mammogram every year. I told her that I did not have insurance (they hired me as an independent contractor) and could not find an affordable individual plan. The implication of course is that they did not pay me enough to afford insurance on my own. She was quiet for a moment and then told me I really should budget myself better in that case, otherwise my death would be my own fault.

  7. Feminist Avatar

    In the UK, we only start doing breast cancer screening at 50 (at which point you are invited to go for a mammogram) and then every 3 years after I think. But, we also encourage (and give out leaflets etc) self-examinations and are told if you feel anything remotely abnormal (for you) you must go for your doctor. At that point you will get a mammogram at any age or other appropriate tests (as my sister discovered at 23). If you have a history of breast cancer (or actually any cancer) in your family, you can see a genetics specialist who helps determine your risks etc and then you may go for screenings regularly at a younger age.

    We are having a similar debate however about cervical smears. In Scotland, we start doing smears at 21, but in the rest of the UK its 25 or 27 or something and recently we had a number of high profile people die from cervical cancer in their early twenties, so there is a push to bring down the age of standard screening to be in line with Scotland.

    On the other hand, we don’t care so much about anxiety as we can get valium on the National Health Service.

  8. MPR

    “If they did give a crap, they’d make rape illegal or something.”

    But if you can’t rape the sex class, who can you rape?

  9. birkwearingblamer

    I have a breast tumor in my 30′s. I saw four different drs over a 6 month period before I found a surgeon who would take me seriously and remove it. Patronizing pats on the head is what I got from 3 drs. Fortunately, it was benign. The surgeon said it was active and a good thing that he removed it. How many drs are ignoring potentially fatal lumps in young women’s breasts? Apparently a lot of them.

  10. PhysioProf

    The general issue described eloquently by Nails is key. False positive diagnoses can have significant adverse effects beyond just anxiety and fear in the person falsely diagnosed. These can include harmful medical intervention to the person diagnosed as well as fruitless diversion of limited medical resources. Whether the mammography recommendations are based on these real considerations, I do not know.

  11. Orange

    An honest question for you, Jill: Was it the cancer that made you pretty fucking sick, or the cancer treatment?

    I am trying to wrap my head around a discussion I had with a doctor friend, and wondering if I need a massive paradigm shift. How many of the people who get rid of their cancers via surgery/chemo/radiation would have progressed to being mortally ill from the cancer itself? Is there overtreatment in patients who will be OK over the long term even without chemo, etc.? I don’t question the value of antibiotics and anti-inflammatories, but then again, they don’t routinely poison the body the way chemo and radiation do. If medical science can’t reliably distinguish between “cancer that will kill you, even if you get treatment,” “cancer that will kill you unless you treat it,” and “cancer that won’t kill you,” I don’t know how one could advise a young patient to bypass treatment.

    I’m yammering here. I’ll go now.

  12. ambivalent academic

    Yes the “false positives may end up getting unnecessary harmful treatments” argument is one that needs careful consideration. However, how many people are willing run the risk of being a false positive in exchange for a lower risk of being the false negative who dies of untreated cancer? *raises hand*

  13. Amanda

    I hope this question isn’t too lobe-blowing considering your derision for “social networking,” but can I post a link to this on my facebook page? Although I realize that the former high school classmates that make up my facebook “friends” will utterly fail to comprehend their significance, I keep posting various links, videos, and the like in an attempt to balance out the racist/sexist/various-other-ists attitudes that abound there. Naive? Perhaps, but I’m 22 and still idealistic.

  14. thebewilderness

    Breaking news from the Highway Safety Commission:
    Looking both ways before crossing the street has been determined to be anxiety inducing in ladies. Therefore the HSC recommends that ladies practice leaping out of the way of speeding automobiles instead.

  15. Larkspur

    Should I ever be diagnosed with breast cancer, of course I’m going to base my treatment preferences on the staging and assessment of the tumor. Unless it’s already metastatic, or unless more than one doc recommends surgery and radiation only, I’m going to use whatever godawful primitive chemo-bludgeon treatment I can get. It’s ugly and debilitating, but it’s what we have right now.

    When I was 49, I noticed the tiniest bead of clear fluid on my left nipple. No, it wasn’t a shower drop, it was a discharge. It’s said to be not uncommon, but in my book it was pretty damned bizarre, because nothing had ever come out of my nipples before, ever. Mammogram, sonogram, needle biopsy, all inconclusive. So I had a lumpectomy. My surgeon said that although the mass wasn’t highly suspicious (as far as she could tell from the imaging), it had to come out and it had to be assessed. Yay for me, best news ever, it was benign, totally not precancerous or anything.

    Did I get over-treated? I don’t think so. I had insurance at the time, lucky for me, and it was expensive, but I can’t see that a mistake was made. It’s not like they ordered radiation “just to be safe”. But after the benign diagnosis, I guess you could say that watchful waiting would have been appropriate. But my surgeon didn’t want to roll the dice, and neither did I.

  16. Aunty Christ

    Y’know, I was overjoyed when I first heard this report. I’ll save a little time, I thought, and a little money. Plus those darn mammograms are so uncomfortable, I hear. Frankly, I had a colposcopy last year, and I nearly came to the conclusion that next time I’ll just die, thank you.

    You make a good point, though. In hindsight, regular testing is more palatable than a preventable death. Just to be spiteful, if nothing else.

  17. madeleine

    Something else they overlooked:

    http://newsone.com/nation/new-mammogram-guidelines-could-have-devastating-effect-on-black-women/

    “The U.S. Department of Health reports that Black women ages 35 to 44 have a breast cancer death rate more than twice that of white women in the same age group.”
    “Plenty of African-American women get regular breast cancer that looks like white women’s breast cancer, but nearly one-third of breast cancers diagnosed in Black women are an especially aggressive and fast-developing type called “triple negative,” which is resistant to traditional forms of treatment. When it comes to triple negative breast cancer, it’s a kind of ‘interval cancer’ that can sneak up in the time between mammograms. “By the time you find it by feeling it or finding it at a significant size, it’s not stage 1 anymore.”

  18. agasaya

    The issue remains that self exams and mammograms advance early detection. That is the purpose of screening and it is helpful if it merely shows us how ineffective treatment is at early stages. Might make people want to actually ban carcinogens.

    You can’t fight what you don’t see or predict the course of smaller tumors without such data. In fact, the statistics showing relatively low changes in mortality are skewed because of rising incidence. That offsets outcome data.

    The real issue is malpractice cases. All explained below:

    http://www.ajronline.org/cgi/content/full/180/5/1229

    Interesting quote:

    “Fieg’s conclusion was that despite a 24% increase in breast cancer incidence in the interval 1983-1997, the fact that a reduction of 15% in mortality rates from the disease occurred meant that mammography was quite effective.”

    It is remarkable that a 15% reduction in mortality (for women) is considered insignificant. The Swedish estimate is 21% reduction for early detection. Pardon us if that appears ‘wasteful’.

  19. Emily WK

    Pardon my ignorance if this isn’t the case, but I had also thought that part of why the recommendation was being reexamined was that maybe shooting x-rays into the place where you could potentially get cancer on a regular basis isn’t such a good idea.

  20. Carrie

    May I respectfully ask that you take a look at this post from a breast cancer surgeon regarding the new recommendations? http://tiny.cc/SzpWu
    Really, he’s written a series of posts about this issue, and did what I think is an excellent job of explaining exactly what the issues are involved as well as how poorly this announcement was handled. Short-ish version: Most young women’s cancers are not found by screening mammograms (we are not talking about diagnostic mammograms for women who find lumps), and what one woman finds an acceptable level of risk is different than another’s. The new guidelines essentially state that the decision to have mammograms in an asymptomatic woman at average risk in her 40s should be made with her physician, because of the risks of overtreatment. He also talks specifically about the “anxiety” issue, and feels that is a serious misreading of the guidelines. Anyway, I’ve learned a ton. I’ll go back to lurking now.

  21. Pinko Punko

    I think nails gets to the heart of it, although I think that this issue has been described incorrectly in other places. It is a very difficult question. I think Orac on Scienceblogs had a very informative post about this. The issue to me is the human/health (not financial) cost of surgery and chemo and putting women through the ringer when outcomes may not be strongly affected. It is a tough situation.

    I agree that BRCA1/2 screening should be fracking free. Very soon the test will cost more than getting your entire genome sequenced. This is f***ing ridiculous.

    Unrelated to cancer, but relating to the female body, I saw an ad for Reebok Easy Tone shoes that pretty much made everybody in the room’s jaw drop. The ad featured boobs purportedly talking to ass, jealous of its new shape thanks to Reebok. Platonic knobjectivism. It was unbelievable yet totally believable at the same time.

  22. Laughingrat

    Somehow it is still shocking that men hate us so very much they would rather we just drop the hell dead.

    False positives suck. You know what else sucks? Dying of breast cancer. I’m pretty sure that sucks worse than false positives. I wonder if it occurs to the medical- and social-policy makers that the women under 50 who die of breast cancer each year aren’t just a fluctuation in statistics, but actually human, actually dead beings. Then again, our humanity’s barely been a consideration to ‘em before. There goes my perpetual naivete again.

  23. Kossack

    Also relevant: http://www.nytimes.com/2009/11/13/health/research/13prevent.html?ref=health&pagewanted=all.

    The ideal scenario is to have Jill’s free genetic screening combined with a risk profile to include weighting risk for family history, age of first menstruation as this varies cumulative estrogen exposure, and environmental risk factors. PLUS one of the (CHEAP) preventive drugs for high-risk folks mentioned in that NYT piece, also free.

    We would save tons in collective funds as a matter of public policy, since in general cancer treatments run individuals into the ground and the group (the insurance policy group, the hospital system group, and the society writ large group) ends up picking up the costs one way or another.

    Plus, we would save lives.

    It’s a win on the fiscal and human sides.

    Incidentally, the Susan G. Komen Foundation could make this reform happen with a sneeze. Okay, okay, a sneeze and a truckload of annoying pink ribbons.

  24. Jezebella

    At 42, my Blue Cross insurance fully covers an annual mammogram, and has for two years. By the time I am 43, I have no doubt they will have undoubtedly STOPPED covering said mammogram on account of these recommendations. I have no doubt that the cost savings associated with cancelling mammos for the 40-50 cohort weighed heavily in the new recommendations.

    @birkwearingblamer, I got the same patronizing pat on the head from the first surgeon I saw about a lump that showed up on what was supposed to be my baseline mammo. At 35, he said, I was “too young for breast cancer.” I fired him forthwith, and found a surgeon willing to do a biopsy. It’s benign, thank dog, but if it hadn’t been, if I had believed arrogant head-patting surgeon #1, well, I could also have been dead, dead, dead.

  25. agasaya

    That NY Times article didn’t name a single ‘preventive’ course of action. Drugs don’t prevent cancer, they treat the effects of what inflammatory processes are set in motion by toxicants in the environment. Cell mutations have causes as do endocrine imbalances from excess exposure to estrogen thrown into every product in the marketplace. The woman haters even call estrogenic substances “anti-androgens” since they are only concerned wtih the effects upon males. Illness in women is too profitable to stop.

    The most ass-backwards approach to medicine I’ve ever seen. And, BTW, one of the researchers of that HPV vaccine no longer endorses it due to hazards and very limited efficacy. Dr. Diane Harper of Dartmouth, paid by the drug manufacturer to test it, recently reversed her initial endorsement of Guardisil.

    If anyone wants them, I’ll dig up the references for these issues. Part of the research I’ve been doing for years due to my own environmentally induced illness. You don’t treat for poisoning and call it preventive medicine. Vitamin A and the other supplements promote detoxification but can wind up being toxic themselves to damaged sulfation systems. Thanks for this reference. I’ll be sure to blog about it when I’m up to it.

  26. nails

    The only thing I found Dr. Harper saying was that the trials proccess was rushed and that it should have gone slower, and on some less credible websites that younger girls shouldn’t take it until extensive testing is done. I haven’t been able to find anything about her reversing her assessment of the vaccine though, outside of sketchy anti vaccine websites.

    agasaya- I am eager to read your blog about this whenever you post it, to check out the details of your claims.

  27. agasaya

    Yes, mainstream sources are always preferable.

    Diane Harper of Dartmouth was optimistic in 2008

    http://www.medscape.com/viewarticle/578110

    and far less enthusiastic in 2009

    http://www.cbsnews.com/stories/2009/08/19/cbsnews_investigates/main5253431.shtml

  28. Bushfire

    “I slurp down a couple of Ativans every morning with my Bloody Mary or I can’t leave the house.”

    How I would love two Ativans every day!

  29. Notorious Ph.D.

    “…the HSC recommends that ladies practice leaping out of the way of speeding automobiles instead.”

    Don’t be silly, bewilderness. A real lady waits in traffic for a man to rescue her from the oncoming car.

  30. MPR

    “Okay, okay, a sneeze and a truckload of annoying pink ribbons.”

    Just today in the store I noticed that the Energizer bunny has hopped on the pink bus. Not just by putting a pink ribbon on the battery package, but by making the actual batteries *pink*.

    You know, for girls. And boobs.

    This whole mess of inaccessible health care/cancer/pink ribbons (followed by a dose of Pepto Bismol for the ensuing nausea) is so stupak.

  31. Absotively

    The main argument I have heard against the necessity of self exams is that women who don’t do them generally still notice when their boobs develop lumps, and that it doesn’t take them all that much longer to notice than it does women who do the exams, so they aren’t much later getting treatment.

    Usually this is accompanied by advice that women should instead get to know what their boobs look and feel like, so as to detect any changes immediately. This is always phrased as though we would never think to look at or feel our own boobs without someone telling us it’s good for our health.

  32. magriff

    Fuck it, I don’t buy the “more harm in early testing and biopsies than good” argument. Not for one fucking second. WTF people. Ok genetic testing would be totally cool but for now we have processes that work: mammograms every year after 40, and paps once a year after 18. Why are these things suddenly thrown under the bus? Because the patriarchy is gonna take those things away from you (if you make <$ 75,00 or so a year) and your daughters soon if you don't fight for them.

    Since when did we stop listening to our local Planned Parenthood ladies?? Their "anecdotal" evidence is still plenty good enough for me.

    Seriously, stop it with the guessing at science.

  33. Miranda

    Jill was diagnosed at 46. My grandmother was diagnosed at 46. My close friend’s grandmother was diagnosed last week at age 78. So Jill, if you need help shoving your malignant tumor up the collective ass of those who think the risk of spending money treating benign tumors outweighs the lives that are saved through early detection, sign me up. This will be a massive project since most people rank women’s health somewhere below whether store-brand Doritos taste as good as the originals, but I’ve got enough anger to get me through it.

    If the people on this task force were really concerned about reducing women’s anxiety over breast cancer, they would make the genetic testing you discussed available to all women. I have a family history of breast cancer, and knowing whether I inherited that gene mutation would do wonders for my anxiety. But no, they won’t help fund that testing. Instead, women should just be willfully ignorant of our own health. Because if a woman doesn’t know she has breast cancer, it can’t kill her. Well, it can, but at least she won’t be anxious about it. Anxious women are just so unpleasant. Plus women won’t chop off our boobies as long as we don’t know about the cancer, so men will always have something to ogle! Yay!

    It might be best if us women folk just went ahead and adopted this willful ignorance plan throughout our life. Like if you’re running low on money, don’t go and check your bank account balance to make sure you don’t overdraft. That will just give you frown-lines, and no one likes those!

    The really great thing about this study is that we now know the importance of avoiding unnecessary medical procedures. Instead of wasting our time and money on silly things like mammograms that might save our lives, we should focus on the truly important medical stuff- like Botox and Latisse for our life-threatening wrinkles and often deadly problems with inadequate eyelashes.

    Oh thank you kind Preventative Services Task Force!

  34. madeleine

    The argument for less screening above 75 years is that at that age a significant percentage of diagnosed cancers are so slow-developing that the patient has more chance of dying at a later time of other age-related causes. Instead many are killed quickly by the unnecessary treatment. Clearly those women have forfeited their rights to both pink-beribboned teddybears and research funds by outliving their usefulness to the Patriarchy.
    I don’t have a link so I don’t know the percentages, but I do know what to blame.

  35. yttik

    If the purpose of this study was to address the fact that women are being aggressively over treated, sometimes to the detriment of their health, that would be one thing. Instead the study turned around and attempted to blame women and their anxiety for failings of the medical system.

    Women’s anxiety and concern for their health is the only normal, natural, and healthy part of the equation. Fear of malpractice lawsuits, pharmaceutical profits, insurance company dictates, and misogyny, are not. It is anxiety about those things that often drives our medical system off course, not breast self exams.

  36. Jill

    “maybe shooting x-rays into the place where you could potentially get cancer on a regular basis isn’t such a good idea.”

    If this were the case — and obviously it’s not healthful to shoot ex-rays into anyone — so what I mean is, if the objective of the task force was to hip women to a breast cancer/mammomgraphy link, they’d say so, and CNN would be shouting “MAMMOGRAMS CAUSE CANCER!” from the cell towers. But no, what they’re saying is “anxiety” and “unnecessary procedures.”

    A woman should get a free fucking mammogram anytime she wants one. They’re so unpleasant, I can’t imagine a stampede of women trying to jump on the free mammogram bandwagon if they didn’t think they had a real reason to be there.

  37. Jill

    Women over 75 are not idiots; why shouldn’t they be able to get all the facts concerning their personal bodily health and make decisions based thereon? The task force is viewing them as nothing but dried up old burdensome excrescences. What if they want to do chemo? For some reason?

    What’s really chapping the Twisty hide about this is the fucking paternalistic tone of the thing, and the thinly veiled you’re-just-a-statistic motif. Sure, maybe “most” women over 75 die of something besides geriatric-onset breast cancer, but what if you’re not one of the “most”? I wasn’t one of “most” women under 50, and I know plenty more under-50′s who’ve gotten breast cancer. Yeah, it’s anecdotal, but seriously. Is there anybody reading this who doesn’t know somebody who’s had it or died from it or just got their diagnosis and is freaking the fuck out about it? The task force implies that, though following the recommendations will undeniably kill some women, its a loss they’re willing to live with. Women are expendable resources.

  38. Jill

    “An honest question for you, Jill: Was it the cancer that made you pretty fucking sick, or the cancer treatment?”

    Yes.

  39. Aerik

    I think you have some misunderstandings, Jill.

    Before fifty, routine breast examinations (not any) had extremely low successful rates of saving lives. But routine examinations here, they’re talking about going to your doctor every six months and getting x-rays. The part where the harm outweighed the benefits comes into play when the x-rays done on women’s breasts began raising higher risks of causing cancer than the chances of said x-ray of detecting fatal incidences of cancer.

    Second, it wasn’t the government’s decision to make this recommendation. It was the doctors’. They did it on their own.

  40. goblinbee

    Question for blamers:

    My daughter (age 27) recently found a lump in her breast and went to the free clinic here in Portland. They examined her and said she had three “nodules,” and gave her a voucher to have an ultrasound done at a hospital.

    Does anyone know how how reliable an ultrasound is, or have any other information about this?

  41. Antoinette Niebieszczanski

    Goblinbee, an ultrasound told my doctor that the whatsit in my left boob is a compound cyst (it’s been there for about 10 yrs. now) and bears watching from one mammogram to the next.

  42. goblinbee

    Antoinette, so I’m wondering if, since my daughter is only 27, she will even be getting mammograms.

    Are there risks with ultrasounds like I’m assuming there are with mammograms?

  43. Orange

    Ultrasounds use sound waves, not radiation. There are those who suspect that the sound waves can cause harm, but I feel that ultrasound is much, much safer than X-ray radiation.

    Mind you, I take the radiation risk when I feel the benefits outweigh the risks, as in dental X-rays, assessing bone/joint injuries, checking lungs for pneumonia, and having the occasional mammogram.

  44. notalady

    @thebewilderness: Thank you!

    Ideally, the substance of a story like this ought to be research summaries, not edicts. The different “experts” are competitive about which of them is right, and which of them gets to herd the women-folk.

    Just as it has to be okay to get a mammo if you want one, it has to be okay to say no thanks.

  45. CassieC

    Goblinbee,

    my breasts are 100% cyst/nodules. They can see them very well on the ultrasound – usually harmless. The ultrasound is 100% harmless as far as I can tell (I’m a physicist).

  46. yttik

    Wow, we have a trifecta of misogyny happening this week. First they come for abortions, then they come for mammograms, and now they are recommending no pap smears for anybody under 21.

    Once again the claim is that they wish to reduce anxiety, decrease unnecessary testing, and prevent potentially harmful treatments.

    http://www.nytimes.com/2009/11/20/health/20pap.html

    No word yet yet on when they might start researching the anxiety producing results of viagra sales.

  47. Penny

    Heard on NPR that they’ve pulled the same crap with pap smears. Something about how it alarms young women.

  48. madeleine

    Jill: I absolutely agree with you on the women over 75. The point I was trying to make is that they cannot ‘get all the facts concerning their personal bodily health’ as no-one can tell the difference between cancers that should be treated and those that should not.
    Both in the old and the new scenario women of diverse ages die needlessly, are seen as no more than statistics and are not deemed worthy of enough research funds.

    Ultrasounds/mammograms: here health coverage is both obligatory and affordable, so I will be having my 8th ultrasound soon. Up till now all my lumps were cysts. For every new one I get both an ultrasound and mammogram, then for checkup after 6 months just an ultrasound, unless there’s the slightest doubt about the results, then I get a mammogram too. This is the established way of doing the diagnosis. The reason is that ultrasounds are safe and relatively cheap but not quite as clear sometimes.

    The anxiety is real and enormous every time, but making sure I’m not harboring an undetected cancer seems to help very well against that for some weird reason.

  49. Adoogs

    I think everyone here probably agrees that sarcasm is one of the best survival tactics around (for the prevention of aggression and/or lobe-blowing). For this reason, my initial response was something like “Hmm, what’s going on in the minds of the rich gov’t dudes who fund this task-force (the one telling us not to do self-exams)? That unless they’re the ones doing the examining, then nobody should be touching these tits? If they can’t play with the funbags, then neither can the women who carry them around all day.”

    Like I said, survival tactic.

    In other news, stay away from the cervix, too!
    http://www.nytimes.com/2009/11/20/health/20pap.html

  50. goblinbee

    “No word yet on when they might start researching the anxiety producing results of viagra sales.” (yttik)

    Ha!

  51. Jezebella

    So they’re proposing we stop having PAPs and mammos to reduce anxiety? I believe the level of anxiety produced by medical tests would be far easier to tolerate if we didn’t have any anxiety about, say, rape and sexual assault, poverty, or domestic violence.

    We need a blue-ribbon commission composed entirely of women to issue edicts regarding reducing female anxiety. First up: ankle bracelets with GPS for all adult males. House arrest for prior offendors. I know *I* would breathe easier.

  52. birkwearingblamer

    Goblinbee, aspiration of cells is better than ultrasound. Push for that. You will have to push.

    This from the medical establishment that said I got endometriosis because I was too up tight and career oriented at the ripe age of 20. Including Christine Northrup, who may kiss my rear end.

  53. Larkspur

    I want to thank everyone here who has posted their thoughts on why we should examine these new edicts or guidelines for the useful questions they do raise. None of us likes the patronizing tone that implies that women’s anxiety needs to be controlled and managed as though we’re livestock that might stampede at any second. We can separate that stuff out while still considering the science.

    Several of you have pointed out very good reasons for us to keep re-visiting the guidelines as science advances, and that makes a lot of sense. It’s given me a lot to think about.

  54. Jezebella

    Birkwearingblamer, I had to look up that Northrup woman, never heard of her. Her description of endometriosis starts out all science-y and normal, and then, abruptly, the woo swoops in: “The uterus is related energetically to a woman’s innermost sense of self and her inner world. It is symbolic of her dreams and the selves to which she would like to give birth. Its state of health reflects her inner emotional reality and her belief in herself at the deepest level.”

    REALLY? For fucks’ sake. I tried looking up breast cancer, but you have to register for more than one search. Wev. I’m sure it’s just as useless and woo-woo.

  55. Adoogs

    Sorry for the repeat on yttik’s NYTimes link–her comment wasn’t posted yet when I submitted my initial response for moderation.

  56. Medstudent

    There is a lot of anger here.

    As a female med student I’ve gone through my surgery and obstetrics/gynecology rotations and heard a lot about these topics. I think there may be a big disconnect between the intent of these recommendations and how the media and the general population is interpreting them.

    Please don’t think I’m sticking up for the patriarchy, or asserting that no one has the right to be angry. But there is legitimate reasoning and data behind where these recs are coming from.

    Mammograms are fairly useless for low-risk young women. Younger women have dense breast tissue that make it very, very difficult to see anything abnormal. Because of this, they get called back for biopsy of tissue that ends up being completely healthy. This is not to say that call-backs and biopsies shouldn’t be done to “save women from their anxiety” but it does cause harm. Biopsy scars can also interfere with later mammograms and hinder identification of truly malignant processes.

    We know from epidemiology that cancers in young women are rare and tend to be very aggressive, which means that in those few unfortunate women who have them, they can show up even between annual mammograms. This is where data about family history of breast, ovarian, colon, and prostate cancers come in to help identify high-risk women and get BRCA testing and early and frequent cancer screening.

    The rest of the population *tends* to suffer more harm than benefit from the time and cost of mammograms until the age of 40 or 50. If we could figure out how to identify all high-risk women, we could screen them early and save the rest of the populace the time, money, and worry. We’re still working on that.

    We only have X amount of healthcare dollars, and the health care system is desperately trying to figure out how we’re going to spend that money. I am NOT saying that we shouldn’t spend money on mammography and early identification. I am NOT saying that women should blindly trust their doctors to make decisions for them. I’m just pointing out that this sort of cost/benefit analysis is going on in all medical specialties. I would hate to spend all of our money on unnecessary screening of ANYTHING when we could be using it in other, more health-promoting ways.

    If I remember correctly, the USPSTF has no official opinion on prostate cancer screening with PSA for very similar cost/benefit reasons. I could be wrong.

    IBTP for medicine not knowing to better prevent, treat, and cure breast cancer.

  57. DaisyDeadhead

    Great comments, Twisty. I have been upset over this fiasco all week long… I am 52 and my mother had breast cancer at age 54… I was a reasonably well-behaved girl and had my first mammogram at 42.

    Like many women who have had their boobs painfully smooshed, I put off the second until 47. I haven’t had once since, and who knew I was ahead of the curve, huh?

    But I was instantly worried; no way to win on this one.

    That’s right, the U.S. Preventative Services Task Force says women shouldn’t be taught to touch their own boobs. The harm outweighs the benefits!

    I thought I must be hearing that wrong. You mean, I didn’t?

    *headdesk*

  58. Mordant Espier

    if the objective of the task force was to hip women to a breast cancer/mammomgraphy link

    That wasn’t the objective. As I understand it, the issue with the screenings is that from the data they have now, it’s seems close to a wash. That is, for every woman between 40 and 50 whose cancer is caught earlier enough to make a difference in treatment outcomes, another woman gets cancer from the x-ray.

    Given that it’s a wash, the false positives, overtreatment, and “psychological factors” are what tipped the recommendation. But they only gave it a “C” priority, which means that it’s not a strong recommendation at all, that they think the benefits of their recommendation are small, and that the recommendation should be overridden based on individual factors.

    While the risk from x-rays remains the same, the risk of developing cancer goes up with age, which is why they still recommend screening everyone, risk factors or not, biennially starting at 50.

    That doesn’t mean women shouldn’t get screened earlier. If you have risk factors, they do state that you should consider screening earlier and more frequently. This means family history, weight, race, mutations if you know them, etc.

    I actually think this report has been vastly mishandled by the media, which you rightly point out can’t handle nuance. The reason they aren’t MAMMOGRAMS CAUSE CANCER! is because they’d have to read the research, not just other people’s summaries of the report’s cover page.

    The task force actually puts the decision in the woman’s hands, and she’s supposed to discuss with her doctor how often she wants to be screened based on her weighing of the risks. Why is this paternalistic?

    They DID NOT say women over 75 aren’t worth screening. They didn’t say anything about women over 75, didn’t give recommendations for women over 75, because they didn’t have any conclusive evidence about what, if anything, would be better or worse than the current guidelines.

  59. pheenobarbidoll

    The American Cancer Society evidently has an issue with these new recommendations too.

  60. Orange

    Ooh, I’d love to see Jill’s take on Christine Northrup–though it’s terribly rude to ask a blogger to write about something in particular, and Amanda Marcotte already tackled Northrup at Pandagon after Northrup was written about in Newsweek (or Time?) a few months back. The gist was that Northrup is an MD, Oprah likes to have her on the show, and Northrup’s pretty sure that women tend to have thyroid problems because they swallow their anger and apparently that nettles the thyroid gland. Haven’t read nor seen Northrup, and hope not to.

  61. SargassoSea

    Mordant – you may want to have your sarcasm lobe checked. I think the guidelines suggest ultrasound.

  62. Jill

    You can be a “female med student” and cite statistics all you want, but when you become a female breast cancer patient you’ll change your tune. These recommendations may be based on what passes for unassailable science, but I’m sure I’m not the only one in the history of the world whose family history revealed none of the vaunted “risk factors” and who still got sick in her mid-forties. My point is that cost/benefit analyses and “risk factors” may well have sweeping implications for the insurance conglomerates and government agencies who have to pay for these tests, but they have no meaning whatsoever to the individual.

  63. Medstudent

    Jill:

    Of course these guidelines can’t have meaning for the individual. They’re National. Guidelines. Broad. Sweeping. General instructions on how to figure out when a woman of average risk should generally start receiving a medical intervention that may or may not help her.

    I’m not saying women shouldn’t be angry, I’m not saying that the patriarchy isn’t contributing to the problem, and I’m not saying it’s ok that we don’t know how to help women who have no known risk factors who still somehow end up with cancer when statistically they shouldn’t.

    I’m saying that a national committee trying to decide how we should use medical dollars wisely is going to provide general knowledge that, like all medical decision-making, needs to be tailored to the individual patient.

  64. Jill

    “They’re National. Guidelines. Broad. Sweeping.”

    Don’t get snippy with me, young lady!

  65. polly styrene

    The problem with ‘breast self examination’ is that I have heard so many conflicting sets of instructions as to how it should be done, I just dismissed it as pointless. Which means that when it was officially dismissed as pointless, I for one was more than relieved, though my GP keeps asking me if I do it – she has obviously not read up on the latest advice, being a mere medical practitioner. And then you are told you should be ‘breast aware’?

    What the medical profession needs to do is stop giving out conflicting advice every two minutes.

  66. j

    In addition to the anxiety drummed up in any individual facing a long and unwanted relationship with the medical establishment (also a big part of the patriarchy infrastructure) to treat a potentially fatal disease, it is necessary to consider the anxiety suffered by women who face losing their breast(s) that stems from the unyielding connection patriarchy steadfastly maintains between women’s identities and their breasts.

    That is, the equation seen through patriarchy goggles looks somewhat like this:

    If, body + breasts = woman

    then, body – breasts = ?

    Pop-media talk around breast cancer commonly includes images of women breast cancer survivors who underwent mastectomy talking about how they ‘just want their breast(s) back’ so that they can ‘feel like a woman again’ or ‘for their husbands sake’.

    Once over the life threatening illness, I wold say that the anxiety continues, in spades, fueled by the patriarchy math machine that equates breasts with a woman’s utility.

  67. tinfoil hattie

    Plus women won’t chop off our boobies as long as we don’t know about the cancer, so men will always have something to ogle! Yay!

    It is, after all, about “sav(ing) the ta-tas.”

  68. Medstudent

    Wasn’t being snippy, was trying to make a point.

    Guess I’ll go sit quietly in my corner like a good girl and not say anything else. Wouldn’t want to say anything to make someone mad.

    Truly sorry that I pissed you off, disappointed in the fact that my point wasn’t heard.

  69. Adoogs

    Medstudent:
    Your point *was* heard. You covered your bases. Nobody is directly disagreeing with what you’re saying; just broadening your arguments. You’re right to point out the complicated nature of the issue, and you’re even more right to “not” say that “women shouldn’t be angry.”

    The point is that regardless of how complicated all of this is, placating those who are upset is not the way forward. Because of the important problems (which you also acknowledge) that remain, it is necessary to remain upset. If women were to just sit back and digest your well-informed, thoughtful, reasonable statements, we would become complacent. And nothing would change.

  70. Ayla

    I am thoroughly confused by some of the comments here, so maybe someone can help clear it up.

    The point seems to be that some medical tests/procedures have little statistical impact on beast cancer deaths for women under 50, and that brought on this gov’t panel recommendation and subsequent patriarchy blaming comments here.

    What I don’t get is this. I haven’t seen anything to suggest that these medical tests/procedures have NO impact on deaths, just that that the impact is low, statistically speaking.

    So my question for those defending (for lack of a better word) this recommendation is, at what point is a reduction in cancer deaths statistically significant enough that a gov’t panel shouldn’t recommend against certain tests/procedures? 10%? 1%? .01%? I’m just trying to understand where the line is here.

  71. birkwearingblamer

    Since medstudent mentioned PSA:

    Blamers will be glad to know that the medical establishment’s callousness towards fatalities and obsession with saving a few bucks are not limited to women alone.

    “The American College of Preventive Medicine (ACPM) concluded that there is insufficient evidence to recommend routine prostate cancer screening testing… not even recommended for high-risk groups… Several other organizations have adopted a similar position, including the American Academy of Family Physicians, US Preventive Services Task Force, and American College of Physicians.”

    “The relative 5-year survival rate of patients with prostate cancer has increased from approximately 75% before the PSA era to 99% in the PSA era (a larger increase than for any other cancer site). Prostate cancer death rates have decreased 35% in the United States in the PSA screening era, and statistical modeling studies suggest that 45% to 70% of this decrease is due to PSA screening.”

  72. Gayle

    Polly,

    Three different Docs, including a breast surgeon, have told me not to worry too much about performing monthly breast exams as outlined in the manuals.

    You really just need to pay attention and “get to know your breasts.”

    Helpful tip communicated to me by the experts above: Don’t use sponges or loofahs or those cute exfoliating mittens every time you shower. They tend to keep us from feeling lumps early on.

  73. goblinbee

    Medstudent, this is such an important topic to discuss and get clear about (as clear as we can), and I have really appreciated your perspective and the information you have provided. Thank you!

  74. Jill

    “Guess I’ll go sit quietly in my corner like a good girl and not say anything else. Wouldn’t want to say anything to make someone mad.”

    Don’t get pouty with me, young lady!

    Really, I get what you’re saying. I just have a problem accepting it and moving on. Ayla manages to articulate my issues better than I have when she wonders where we should draw the line re: acceptable casualty rates. I, for one, am pretty pleased not to have ended up on the wrong side of that graph.

  75. j

    RE: Polly and Gayle’s dialogue about advice around breast self exam.

    The thing with ‘advice’ is that it is a great way for individuals/institutions that should otherwise be held responsible to say, “See! I told you should’ve done (fill in the blank ie. breast self-exam ). Now I am just going to go on over here and wash my filthy hands in this here sink.”

    ‘Advice’ about breast-self exam and breast cancer detection, in the absence of a state/nation funded health care system to accurately prevent, detect, and treat breast cancer sets all women up for failure and blame from the patriarchal medical establishment.

    In the view of said medical establishment, women who get breast cancer ‘just aren’t vigilant about prevention.’ For example, by taking steps to afford (better) food, eat healthier, exercise – all the trappings of white, middle-class, lady-hood. Women who don’t detect breast cancer in their own breasts ‘just aren’t vigilant about self-exams’ – they just don’t listen to all of the ‘medically sound expert advice’ being given them.

    Either way, the point is, ‘advice’ makes it your fault. Meting out advice is the most cost effective kind of health ‘care’ around! No matter what happens, the individual is to blame; it is your fault if you get, fail to detect, or succumb to breast cancer.

  76. Janna

    My best friend’s aunt died of breast cancer in her early 40s. As Dr Cox on Scrubs said, “Statistics are meaningless to the individual.” That being said, it’s interesting to me how many individuals on this site know or are someone who got breast cancer before the age of 50.

  77. agasaya

    Why is everyone debating this from the point of view of the premise of these statistics? Don’t accept the premise behind these industrial-medical decisions, just as you reject the patriarchal premises underlying the culture.

    It shouldn’t be about acceptable risk as seen in mortality rates justifying diagnostic procedures. Medicine is about disease at all stages. Early cancer detection has huge value in looking at the disease of carcinogenesis which happens over many years. Masses don’t suddenly appear one morning! Early detection means better ability to look at causational factors closer in time to the appearance of a mass. It is a better time to examine the genetic damage responsible for the abnormal cell growth as well as the physiological states which failed to modulate it.

    Perhaps those in early stages might be candidates for chemopreventative drugs rather than cytotoxic drugs – kind of like starving the cells instead of killing them as well as good cells.

    Cancer is caused by gene damage influencing cell abnormal cell growth at the same time the body can no longer compensate for the introduction of those cancer cells by its safety systems. From my studies, only about five percent of that genetic damage is inherited, the rest is caused by environmental influences and individual physiological risk factors. That is going to be harder to study in late stage cancer. But then, chemo therapy is a hugely profitable business.

    Not knowing you even have cancer removes agency from the patient in terms of making plans for their futures. It removes opportunities to run comparison studies of those taking treatments and those opting out in favor of monitoring. It would certainly demonstrate where treatments are harmful and ineffective. Treating at later stages is an automatic assumption of risk for failure for reasons other than the drug chosen. Have you noticed how industry likes to claim reduced mortality from cancer instead of responding to calls for the examination of increased incidence?

    Frequent mammography does offer some unacceptable risks of cancer. So, why should’t we be getting ultrasounds instead of steady exposures to radiation in between ‘acceptable’ exposures every few years?

    I blame industry for developing the false premises upon which the desirability of early detection is based. It should be about life, not death. And patriarchy isn’t going to care about what it does to women. We’ll ride on the coattails of male concerns regarding rising rates of their own diseases – they aren’t going to want to give up their PSA testing.

  78. zz

    “Statistics are meaningless to the individual.”

    Exactly!

    My Onc insisted that Tamoxifen wasn’t causing my horrific pain because it had been used for years and that that kind of pain was never a side effect noted in the population. I told her that there was a reason a bell curve wasn’t a rectangle. Those ends represent real people with real lives. I told her I was going to find another Onc that would treat me as a person, not a population. That’s pretty much how I felt when I initially read about these recommendations. (BTW, I was diagnosed at 42.)

  79. LeadTimeBias

    (BTW, I was diagnosed at 42.)

    With what? How do you know you weren’t one of those mistakenly diagnosed? This is not to ‘you’ who made this comment but all the ‘you’ defending a pharmaceutical and device company profit driven initiative.

    At last some sense is breaking through and the possibility exists that we can stop being cash cows for the industry. If they want stats to study the inception and progress of cancer, they should have lots of data; since the early ’60s not one thing has changed in cancer treatment: burn, cut and slash. “We do have neater incisions” now an onc surgeon told me ruefully. Even he knows there has been no progress in the ‘fight’ against cancer,in spite of all the women running, fund-raising and dying for the benefit of the industry.

  80. smaller

    Here’s another vote of support for Orac’s series of posts on this issue, which put a more human face on a lot of impersonal data. I encourage anyone still angry over this to read it for a bit of context. The USPSTF recommendations were presented poorly, but they *are* founded upon sound scientific research.

    Medicine and science are never perfect, and when we have to apply broad trends to a huge population, dealing with outliers and the ends of the bell curves will always be problematic. We do what we can, but we do try to find a happy median that can help as many people as possible while harming as few people as possible.

    The recommendations were not made out of callousness, or love of suffering, but by people doing their best to interpret real, and often conflicting and controversial scientific data in the most helpful way possible.

  81. LeadTimeBias

    Amazing. People holding up that women hater ORAC’s thoughts on anything as worthy of consideration on IBTP.

    Apart from the fact that he is a woman hater, ORAC is in conflict of interest for any opinion on breast cancer. He makes his living off it.

    When is someone here going to be allowed to say that alcohol is the largest environmental cause of breast cancer. Clink.

  82. zz

    I went to Orac’s post and read it to this point:

    “A disturbing tack being taken towards the guidelines is the misguided urge to cry, “Misogyny!” No, I’m not saying that there hasn’t been misogyny issuing from the government and other regulatory and academic bodies over women’s health before. There’s been a fairly long history of that, and we are only starting to overcome it. I’m just saying that this isn’t one of those times.”

    Well I feel better knowing this isn’t “one of those times” because, well, he said it wasn’t. Whatever.

  83. Pinko Punko

    zz, Orac posted on this stuff three times this week. He’s a dude, so he’s gonna sound like a dude. He’s also part of the medical industrial complex, he’s a surgeon who also does cancer research. You can conclude he’s part of the problem, or you can examine what he says, trying to filter out possible language triggers and focus on the fact that he knows what he’s talking about. Since a thing called the internet was invented it makes it easier for people to get quoted about stuff and talk about things and generate some rhetorical leverage on all sides of the football. Some individuals have stated that these new recommendations are like “soft death panels” and I think I’d want to ask just what those folks have to gain with their hyperbole.

    If x people get better with a certain treatment but y people don’t and z people’s health gets worse, inevitably there will have to be some sort of math that takes into account the numbers and cost of z plus y people versus x people, until we figure the f*** out about how cancers work. We say “breast cancer” but we mean “cancers of the breast”- they are harder to identify than insects in the Amazon, ever cancer of every tissue is many, many different diseases, which makes guidelines or suggestions for policy end up being based on x,y,z type rationales.

  84. feral

    http://www.msnbc.msn.com/id/34046944/ns/health-cancer/

    In an entirely unrelated (ha!) report, the US government is now recommending that women in their 20s can go two years between pap smears instead of going to the gyno annually. The reason for this conclusion is that cervical cancer has one of the slowest growth rates. Interestingly enough, none of the news releases of the study I’ve seen have mentioned the fact that African American women are twice as likely to develop cervical cancer, and Native-American and Hispanic women also suffer from significantly higher rates of the disease. The governmental panelists claim that surgeries of the cervix can lead to fertility problems and preterm delivery, but I know for a fact that surgeries are only performed on women who have malignant cellular changes. In the long run, I’d much rather not, ahem, die of cancer than carry a child. Fucking receptacles and incubators for the patriarchy; that’s all that matters.

    I worry about this “recommendation” for several reasons. At the age of 24, I developed early stages of cervical cancer and had to go through some pretty gnarly treatments. I’d rather not think about what I may have had to get done if I’d waited two years. Two of my good friends wound up in the same situation. We have always insisted on yearly (or even biannual) exams. We aren’t just faceless statistics. Annual exams aren’t just for detecting possible cervical cancer: they also screen for other life-threatening STDs and conditions. It’s not like dudes are lining up each year to get their junk checked out (the threats that women face due to dudely apathy regarding sexual health is another matter for another day). Many women are already reluctant to go annually; I wonder if this recommendation will lead even more women to wait years between exams.

  85. Deya

    I’ve reached this via a number of feminist blogs. This is a very interesting discussion to me – both my aunts had breast cancer, one in her thirties, one in her early forties, both had bilateral mastectomies and chemo and went into remission; unfortunately the one who was diagnosed in her forties, after two decades of being well, was recently found to have pancreatic cancer and despite a cycle and a half of chemotherapy, passed away in July. I have breast lumps and am thus under surveillance at my local breast clinic (which, lucky me, is not in the US but the UK). Two other women I’ve known, a schoolmate and a colleague, died from breast cancer in their twenties.

    I’m also a doctor. And I’m also a patriarchy blamer which I’ve been for longer than I’ve been a doctor.

    However from reading the recommendations as reported in the Washington Post article I have to blame the way this task force decided to distill its messages to women and doctors.

    I agree with the principle of no routine mammography of the pre-menopausal population, and the key word is routine i.e. regular tests on a whole-population scale.

    A ‘screening’ test is different in public health jargon from an ‘investigation’ test – investigations are something you undergo if you are suspecting a disease, screening is something you undergo if you start out not suspecting. In public health textbooks (and probably emedicine) there is a list of criteria to determine whether a screening test is useful or not, and one creteria is that the screening method has to have few false positives and few false negatives. Mammography in young people is not sensitive or specific enough to be a good screening method. So I agree with the recommendation that it should not be a routine for all women under 50.

    As Medstudent says, for women in their late 40s it remains to be seen what the best screening test is. The UK National screening programme is aiming to reduce its starting age to 47 rather than the present 50 because it plans to introduce digital mammography rather than plain-film as is the case now. Digital mammography in some studies has been shown to be a better method for women over 40 which is what the NHS is basing its move. I’m not sure what is being used in the US (I’m guessing possibly a mix of both, as per the individual’s insurance?) but this recent task force’s conclusion on the type of mammography was that they could not recommend one over the other.

    My main conclusion from this is that all plans for routine screening are based on large, whole-population numbers and we know that a few pre-menopausal women most definitely get and die from breast cancer. Women of all ages should be made aware that if they are concerned about their breasts – from strong family history or after feeling a lump – they should have a discussion with their doctors about their own individual risks, and if necessary have screening tests or investigations.

    Someone mentioned cervical screening and whether the starting age should be kept at 18 years. I haven’t made my mind up about this personally, but in England we are screened every 3 years starting from 25 years. The reason for this starting age from the national public health authority is that the normal under-25 cervix is in a state of perpetual change, cell-wise, therefore a ‘normal’ and ‘abnormal’ smear at this age are too alike and so the smear test is not a good pre-cancer screening method for younger women. Furthermore they speculate that the benefit from the HPV vaccine will be seen in this next generation of screenees. If anyone’s interested in reading a very dry blow-by-blow account of how they arrived at this conclusion it’s on http://www.cancerscreening.nhs.uk/cervical/cervical-review-minutes-20090519.pdf .

    BUT public health authorities should be making women, especially these younger-than-the-starting-age-of-cervical-screening women aware that if they are experiencing any unexpected spotting or bleeding, this could be a symptom of cancer in a small number of cases and they should see their doctor. They should also make women more aware of HPV and what we know so far about how it causes cervical cancer, and how it’s contracted. This is not currently happening.

    Sorry for the giant reply. I’m glad this discussion is happening because I am happy that women are bothered about their collective health. ‘Men’s rights activists’ claim that women’s health gets more money and attention than men’s. This is blatantly untrue. Please continue to be angry at injustice, and please also take time to read the literature behind recommendations. It’s a shame that those in charge of distilling the evidence-base into advice have been doing it in such a shoddy way. We have to try and educate ourselves.

  86. Larkspur

    Reading this post and the comments, I’m learning a lot, and I am beginning to see the huge difference between the recommendations and the coverage of the recommendations.

    But here’s one thing that confuses me, and if I should just go over to Orac, please tell me. The bottom line seems to be that the screening protocols we’ve been doing do not change mortality rates. So some breast cancers, regardless of when they are detected, are going to end up killing you (unless you get hit by that truck or meteor).

    But more and more, we’re seeing women live for many years with breast cancer, to the point that in some cases, it’s more like managing a chronic disease. There are horrible times, like the surgery and the chemo, and less horrible – sometimes really good times – when the cancer is in remission, and you can live your life. I don’t want breast cancer, none of us wants it, but isn’t early detection a good thing if it helps us manage it and live better, longer?

    Do mortality rates reflect this increasing ability to manage certain breast cancers for a good long while? I wonder, too, if they are working on other, adjunct ways to detect breast cancer, or to identify risk markers, ways that don’t irradiate you or involve surgery. And of course, there’s the whole field of figuring out environmental causes and links – even if the links are to substances found in hugely lucrative mass-marketed products or foods.

  87. smaller

    Right, Larkspur, the big issue is that, according to the data we have now, due to the imperfections in detection methods and equipment, excluding high-risk groups of people, screening just doesn’t make a very significant impact for the pre-50 age group, and biennial screening in older women provides nearly the same benefit in terms of early detection, but at half the cost of unneeded procedures and over-treatment. The data that we have now just does not support the claim that yearly screening is especially helpful in younger women at normal risk for breast cancers. There’s always the chance of course that that data could change, and good science demands that our policies and guidelines change to reflect that, hence the contradictory recommendations about various health topic over the decades.

    Early detection is a Very Good Thing in women whose masses were malignant. But there are also plenty of cases where a mass is benign, or where it grows too slowly in an older woman to become life-threatening before she dies of other natural causes first, or even where it spontaneously regresses. We just don’t have the methods yet to be able to tell the killing cancers from the others, and individual screening and treatment must become a balancing act at the patient level. Many people feel that, yes, offuckingcourse they want to be screened every year and treated the hell out of, sure. Some people are 85 with a host of other health problems, and don’t really want to spend your last few years or months going through surgery/radiation/chemo when they find a tumor.

    And you can bet that there is a lot of ongoing research into novel cancer detection, identification, and treatment methods. The university I work at just recently finished building a new center specifically for cancer research, for example, and the field is definitely a big one.

    Really though, I’m in a different field of research (diabetes), so anything I say about cancer is going to be secondhand, coming from general science knowledge and reading what oncologists have to say.
    Orac could definitely give you better context on current trends in breast cancer treatment and survival rates. The 5-year survival for many cancers has increased significantly as a result of better therapies. (And for many, the rate is still very dismal.. the problem of cancer being many many different diseases that we are still trying to unravel.) Here’s an excellent pair of posts from 2007 (can I post links here? I’ll try), and a couple others you might find relevant to your other questions.
    http://scienceblogs.com/insolence/2007/04/detecting_cancer_early_part_1_more_compl.php
    http://scienceblogs.com/insolence/2007/04/early_detection_of_cancer_part_2_breast.php

    http://scienceblogs.com/insolence/2009/08/cancer_research_and_clinical_trials.php

    http://scienceblogs.com/insolence/2007/10/breast_cancer_in_time_magazine.php

  88. smaller

    LeadTimeBias, I’m curious as to why you call Orac a woman-hater. He’s a dude, sure, and (tongue firmly in cheek) therefore not perfect. But it has been my experience from reading his blog that he does try to speak out against misogyny he encounters in science. He is also in good standing with Isis the Scientist, who writes on ScienceBlogs about feminist topics as much as she does about research.

    And what you call “conflict of interest”, I call “expert opinion”. If any unsound science were in evidence from his posts, you might have a point there. But what, you’re saying we’re not supposed to trust professionals to tell us about their profession? That is absurd.

  89. Larkspur

    smaller, thank you so much. I remember as a little kid, hearing the adults talk about finding “the cure” for cancer. Now we know there won’t be one cure. Cancer is like a bizarre parallel universe.

  90. smaller

    Happy to help! I love seeing people take an interest in science.

  91. kel d

    The way it is being sold in the UK is that there are cancers which take a very long time to cause any harm. Catching those cancers with screenings means that the woman will have chemo etc and her quality of life will decrease, where if it were left alone, she would die of something else way before the cancer got worse.

    Also, the more screening they do, the more false positives they find (I am one of those false positives, had a lump removed and everything), which also means misery and suffering.

    However, you would think that they would be trying to improving screening to differentiate between cancers and reduce false positives… and not just do less testing.

  92. LeadTimeBias

    That Isis blog is replete with posts on fuck-me shoes, kittens, pronouncements about who and what is hot looking. I didn’t find the science. But I have a low tolerance for what she’s selling so I didn’t stick around long.

    Barbara Ehrenreich has a post on the new mammography guidelines.

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