All right ladies. Here we go again! Mammograms and guidelines. When do we start having mammograms? How often do we have them? Are they really effective? Do they really save lives? And the biggest question of all: Will the medical community ever make up its mind?
As you recall, mammogram screening has been a tricky topic for years. The boat was really rocked four years ago when the US Preventive Services Task Force, or USPSTF, said that most women should wait until they are fifty to get regular mammograms. The Task Force also said that screening only needed to be conducted every other year.
This idea flew in the face of then accepted guidelines that said most women should begin regular mammogram screening at forty and repeat the procedure every year. General uproar ensued. And last month, the debate reached a new fever pitch when yet another study was published recommending we return to the previous guideline in which forty is the proper age for women to begin screening.
It’s all very ironic considering a guideline is supposed to reduce confusion — not increase it.
So, let’s dissect this mess. We’re talking about our lives, and it’s incredibly important we understand what’s going on.
For most of the last twenty years or so it was generally accepted throughout the medical community that mammogram screening for women should begin at the age of forty. It also was accepted that this screening procedure should — in most cases — be repeated once every year.
In 2009, a report by the USPSTF stated that women should not begin mammogram screening until the age of fifty. The report also said that screening every other year was sufficient. Why did the USPSTF say this? There were two main reasons. The first was that screening women at the age of forty didn’t save enough lives to justify the expense of screening. The second was that screening women at the age of forty exposed women to needless worry and unnecessary procedures that might result from false positive results.
Let’s talk about the first reason. This logic is based upon something known as a cost/benefit analysis. The Task Force decided that not enough of us die from breast cancer between the ages of forty and fifty to make it worthwhile to provide the mammograms that might save us. You see, mammograms cost money. Someone has to pay. And, typically it’s either the government, the medical facilities or the insurance companies.
This is a point of contention. Let’s take an example. Let’s say 500 of us are in the middle of the ocean on a burning ship. A rescue team could save us, but decides not to. They contend that because there are only 500 of us, mounting a rescue would be too expensive and not worth the effort. It would make more ‘CENTS’ to let us die and save the money rather than save our lives. Now, let’s suppose there are 5,000 of us on that burning ship. At this point, a decision to launch a rescue might be supported — because saving 5,000 lives might justify the amount of money the rescue effort would cost.
Ladies, how does that make you feel? Don’t you ever wonder who makes up these Task Forces? Are there any women on them? Don’t the men on them have any women in their lives? Wives, daughters, sisters or mothers? It’s something to think about. In any case, that’s how a cost/benefit analysis works.
Now, let’s talk about the second reason. It’s true that mammograms are not infallible. Sometimes they fail to see a problem that exists. Sometimes they reveal a suspicious spot that turns out to be harmless. This is called a false positive. When women begin screening earlier, more mammograms are conducted. When more mammograms are conducted, the number of false positives may increase. When the number of false positives increases, more women may experience needless worry. And, more women may need to undergo a biopsy before they know the positive result is false.
According to the Task Force, this unnecessary worry is unacceptable –as is the unnecessary medical procedure these women may have to undergo. Now, here you need to remember — the medical procedure typically is also paid for by one of the above-mentioned entities. So, we’re talking about more money that someone doesn’t want to pay out. As a result, the USPSTF concluded that women should just wait until they’re fifty for screening and to repeat it every other year. Saves everybody a lot of trouble.
I don’t know about you, my friends. But, I would rather be alive and experience a bit of needless worry and temporary discomfort — than be dead because I didn’t receive a mammogram that might have saved my life.
Indeed, a mammogram did save my life. And, as many of you know I have always adhered to the guidelines still supported by the American Cancer Society and the National Cancer Institute. Both say most women should begin mammogram screening at the age of forty and should repeat screening once every year.
Last month, a new report was published that once again supports the guidelines of the American Cancer Society and the National Cancer Institute. Conducted by a research team at Harvard Medical School, the study’s crucial finding was based upon the number of women who had never undergone a mammogram and died of breast cancer.
It’s also good to know that under the guidelines of this new study, as well as those of the American Cancer Society and the National Cancer Institute, the 2010 health care law in the United States requires insurers to pay for mammograms without charging patients a co-pay. In addition, Medicare will pay for its patients to undergo a mammogram once every year. What is best for one woman may not be best for another, so this all makes for an excellent topic of discussion with your primary care physician.
And always remember, women who have a history of breast cancer in their family, who have a first degree relative who has or had breast cancer and women who have an anomaly of the BRCA 1 and 2 genes will in all likelihood require screening earlier and more frequently than the guidelines of either the ACS or the NCI.
Hopefully, this helps shed a bit of light on a controversial and confusing topic. For there is one thing we can count on; another study will come along sooner or later that once again will change the guidelines for breast cancer screening. So, until then do your homework and always take a proactive approach to your health! Be informed, be courageous and be bold. Your life depends on it!
Reprinted from my guest post on It’s a Glam Thing for Breast Cancer Awareness Month.
Leave a Comment