Friday, November 20, 2009

Kathleen's Talking Boobs. Seriously.

So you want to mess with my right to bare boobs under the watchful eye of the mammo meter, huh? You call yourself a Task Force? I'll show you force, boys. You can have my mammogram when you take it from my cold, dead breasts.

We've all heard the news from the U.S. Preventive Services Task Force--a panel of 16 medical experts (half of them women) appointed to advise the Department of Health and Human Services on the effectiveness of various screening techniques. They're saying that women in their 40s should not routinely have mammograms and that women over 50 should have mammograms every two years instead of annually. Why? They say that every-other-year screenings could provide 80 percent of the benefits of annual screening while cutting the risks almost in half. And just what are the benefits? Mainly not dying from breast cancer. The risks? The possibility false positives and unnecessary biopsies.

Okay, ladies, let's think about this. This panel is supposed to tell us whether mammograms do more good than harm for women of various ages. But what good are they talking about and what harm? They're talking about statistics. They say that ff screening begins at age 40 and is performed every other year, mortality reduces by a median 19.5% compared with beginning screening at age 50, but false-positives, unnecessary biopsies and anxiety increase.

Mortality. That means if you're in the 19.5%, you're dead. Right? Or am I missing something?

Anxiety. Hmm. Does the picture on the right scare you? Me neither. I've given birth three times and had a kidney removed. I can smile all the way through the mammogram. I've had two breast biopsies--both turned out to be calcifications. Were they unnecessary? Daddy's two sisters died from breast cancer. Just because my results were negative (hooray!) doesn't mean the tests were unnecessary. "Chances are, it' a calcification," the doctor said. "But we can't know for sure without a biopsy." Not having the biopsy is going to give me some anxiety. So I say, let's find out for sure, Doc.

I'm not convinced by statistics. I'm interested in people. I have to check several of the risk boxes when I fill out the form on mammogram day, but I know that most people who get breast cancer--upwards of 80% (some say 75, some say 90)--are not in any of the high risk categories. But I'm wondering what other women know. We need to talk, ladies. Do you have a story to tell? Because that's how women get to be so smart. They talk to each other.

Here's my story. I'm the kind of kid who goes by the rules, so I've always had the annual physical, complete with mammogram starting at 40. When my baby sister reached her 40th birthday, she hemmed and hawed around. "Get thee into the vise," said I. And she did. She had a stage 2 tumor. Malignant. She was a single mom, and her little girl was 5 years old. My sister is a survivor. Now, remember, they used to say that breast cancer on your mother's side was a risk factor, but not your father's side. They used to say a lot of things. In ten years, the new recommendations will fall under the category of what they used to say.

So what do you think of the new report? What have you heard? What's your experience? I'll send out an autographed copy of In Care of Sam Beaudry to one of today's commenters.

P.S. Sam's brother's book, ONE COWBOY, ONE CHRISTMAS, has been spotted at B&N, which is a surprise to me. It's a December book. Merry Thanksgiving!


Anonymous said...

What do I think?

I think if men got breast cancer at the same rate women did, a mammogram would be a sacrement of the church and there'd be no question about yearly testing an at early age.

Statistics can be used to prove anything you want. Did you know that 100% of meth users drank milk as babies? Well by golly, we should ban milk.

Leave my mammogram alone!

Anonymous said...

I'm 31 so I've never had any mammograms. I have my twin girls checked once a year by the gynechologist thaugh. It's not that I can't do it myself but I prefer the expert take on it.
I know I'll have mammograms as soon as I turn 40. Those stats give you too many informations. The only one that really matters to me is that mammograms save lives.
What happened to your seaster is a good reason enough to do the same. (shuddur)

Unknown said...

Hi :)
Thank you for the personal thoughtful post.
I wonder if penises were squished to test if the very next week there was a much-improved technology available?
All the best,

Unknown said...

You go, Kathy! I am not crazy about getting my tata's flattened periodically, but I do it anyway. . . gladly, in fact. My mom and two of her sisters had breast CA and one of my first cousins had a double mastectomy before 40! Anything that increases my chances of living to see my own great grandchildren. . .

As for the panel-- could they have plotted a less auspicious time to report this? Right in the middle of the battle over "the public option" for health care. This is only the first of the rationing. . . and to say it's not that is disingenuous. I'm gravely disappointed in the administration for this. And I can't believe they weren't smarter about the timing. If they didn't know about it, somebody's head needs to roll!

Virginia C said...

Hello, Ladies! This is such a personal and daunting topic for women. Some men do develop breast cancer, but they are in the minority and the stigma is much different. Let's face it, how would men react to having their "dangly bits" mashed, flattened, squeezed and almost ripped from their bodies? Women need to be informed, not frightened and discouraged. We need to stay united, demand honest answers and continue to make enlightened decisions regarding our own healthcare. Think pink : )

gcwhiskas at aol dot com

Helen Brenna said...

Mammograms aren't worth the false positives and resulting anxiety over biopsies?

Since when has the medical community used the anxiety level of patients to determine when any test should be done?

It's all about costs. And as far as I'm concerned there are waaaay too many women under 50 who are survivors because of mammograms, including my sister.

They're not sneaking this one by any of us.

Kathleen Eagle said...

The need for more reliable screening must be a major part of this discussion. Nothing has changed much (my clinic just got the new digital equipment, but otherwise...) during my adulthood, but in that time the mortality rate has gone down due to early detection. And what brought early detection about? It ain't self-examination.

Yep, this will be a good discussion, ladies.

Michele Hauf said...

I've done the squish and probably should head back in soon because it's been a few years.

Yeah, I just kind of shake my head when the news talks about these new recommendations. Whatever. I'll do what I think is smart.

Lori said...

Standing O! As someone in my 40s who has had a 2nd mammogram due to a question on the first, I'll take a little anxiety,thankyouverymuch. And recommending no BSE? What is the matter with these people?!

On another note, today came the recommendation that pap smears not be done annually. Wonder what they're all going to think when the cancer death rate for women starts to rise again. This makes me so hot!

Candace said...

Like Kathy, I'm a rule-following good girl. At least, when it comes to my health. Mammogram every year since I turned 40; PAP smear every year since I was 16; colonoscopy when I turned fifty and again at 55. Yearly thyroid test. Yearly Cholesterol test. And so on.

They've always come out just fine, which saves me a whole lot of anxiety.

No breast cancer in my immediate family but I have two cousins who had "suspicious" mammograms that led to biopsies, that led to finding breast cancer early. Both of them are alive and well because of regular, yearly mammograms.

I will continue to have my boobs squished every year, regardless of what the recommendations are.

Kathleen Eagle said...

Lori, I just saw the pap news this morning. Sheesh! The claim that cost of health care is rising because of too much testing could be true. But I don't think that applies to *screening*. That's not the same thing. I wonder what the difference is in the cost of treating stage 1 vs treating stage 2 vs treating stage 3 or 4? Besides the difference between life and death--I'm wondering about "the bottom line." AKA, dollars.

mslizalou said...

I started having mammograms when I was 35 because I have lumpy breast. I've had multiple biopsies done and everything has come back fine. I trust my doctor and she told me I must have a pap every year and mammograms each year once I turn 40. My health insurance covers both in full for now and I'm hoping they will continue to do so.

BTW, a BSE was the way I found my first lump in my breast when I was 18.

Kathleen Eagle said...

Betina, this panel has been in place for 25 years, and according to news reports their recommendations influence federal programs AND insurance companies. Sebelius has said that this won't change federal policy. Insurance companies? Again, we're talking bottom line.

I'm of the opinion that health care should not be a for-profit industry. There. I said it. The profit motive does not serve the patient. Thank heaven for whatever regulation exists in your state. MN requires insurance companies to cover these screenings. Thank heaven for the American Cancer Society and the American College of Surgeons. Both disagree with the panel's new recommendations.

Pamela Keener said...

In the past year I have had 2 friends who have had mammograms where cancer was discovered. The first friend needed a radical mastectomy at 48. The second friend is being treated with a lumpectomy and radiation. I think the statistics of breast cancer warrant the continuing screening. I had my first lumpectomy at 38 years old. Thankfully it was benign. I really don't want to play russian roullette with my health. What is all this talk about early diagnosis? Is that all to be thrown out with the trash?
Love & Hugs,

Cindy Gerard said...

Right on sister girls!

Kathleen Eagle said...

Pamela, I think your case of a benign tumor is one of those they put into the "unnecessary treatment" category along with my biopsies that revealed calcification. It only counts as necessary if they find and treat a malignancy.

This part bugs me, too: discovering slow-growing cancer that probably wouldn't result in death is also considered "unnecessary." I can just hear some guy in a white coat saying, "It probably won't kill her so let's not worry her pretty little head over it."

LSUReader said...

I think it's unconscionable and hypocritical for the medical community to discourage women from getting mammograms. We have so many victims of breast cancer. This kind of suggestion will negatively influence insurers. Here is a website I visit daily to help fund mammmograms for poor women: It's free--just a click of the mouse helps those in need. Thanks, Kathleen, for calling attention to this in your blog today.

Unknown said...

go Kathy. not for profit healthcare. i'm with you.

Cindy Gerard said...

LSU - I have that link on my website and have it set up to send me DAILY reminders to click. So easy to do.

Linda Henderson said...

Frankly I think this will just give the insurance companies another reason not to pay for something. We have to fight most of them now to get our bills paid. I heard them talking about self exams and how they were basically worthless. If I want to feel myself up to see if I have a lump, what business is it of theirs. After all, we know our bodies better than anyone. A lot of the time we know there is something wrong with us long before a doctor and if you don't insist they keep checking a lot of times things go unnoticed.

Anonymous said...

I'm for the pre-screening tests and the self-examinations.

At 27 I had part of my cervix removed with a laser because my regular pap exam and the subsequent "wait and see" paps and the biopsies identified rep-cancerouse tissue Level 4. This is the stage before they start calling it Cancer Stage 1. If the pap wasn't done regularly along with the cautionary follow-ups, I think it is possible I'd be dead from cancer. Lower possibility because of more effective treatments, but they still aren't great for Cervical Cancer.

This past summer, I had a breast tumor removed that was finally found to be non-cancerous. I won't waste any time thinking about how scared I'd be if they'd told me to avoid the mammograms and other tests and just wait and see. They couldn't tell if it was cancer until the CUT IT OUT and tested it. What? I should have just waited to see if I started having OTHER trouble? Nope, the swelling, bleeding, draininage and PAIN were enough of a sign for me.

I'm 44 now. I'm going back every year for my mammograms. I pray that my insurance continues to pay.

Having said all that/this . . . I STRONGLY believe that better testing methods, equipment and treatments need to be researched for women's health issues. We have plenty of ED drugs avialable now. Redirect the research!

Marcia in OK

Kathleen Eagle said...

Absolutely, Linda. Feel away. We need to do whatever works, whatever contributes to the decline is the mortality rate for breast cancer.

When I searched Google images for the visuals I posted today, you know what else I found? Several photos--all different jokers--of men with a cardboard box over their head and a sign reading "Free Mammograms." Oh, and a big grin. Okay, I try not to take myself too too seriously, and I joke about the squisher. But sometimes I think the powers that be would put women in that cardboard box if it would add to their profits. After all, what's one in 1,900?

Sadly, we're talking about women in their prime. 40-50? Those are some damn good years, girls.

Debra Dixon said...

I loved the Larry King show in which the rep from the Cancer Society was so diplomatic about respecting the Task Force and in the kindest way possible said, "They got this wrong."

And he also said (paraphrasing), "Mammography isn't perfect but it's the best test we have. What we need to be focusing on is a better predictor. Women deserve a better test."

Loved it.

Also loved your post today Kathleen.

Here's my mental process for anyone who hasn't had a mammogram and might be worried about all the "pain and discomfort" they're being told they'd be saved if they follow the new regulations...

DD's thoughts during the mammogram. 'ow. Ow. OW. Oh, done. Next boob?'

Way easier than being treated for breast cancer.

Unknown said...

I have my pap test and mammograms done every year in April, great birthday present. My grandmother died of breast cancer on my father's side. They always told me the risk were less coming through that side of the family but I don't believe it. I started getting mamograms at the age of 35 and I did have one come out bad but they desided it was from to much caffene. I had to have them every three months for a year after that. All of the rest have been fine. I do think men should have the pleasure of having at least one done on themself just so they would know what it was like. There should be an easire way to check for these things.

Lori said...

One last thought, and that was that I notice that nobody told men to stop doing TSE. Hmmm....

Kathleen Eagle said...

Virginia, Lori-- I thought about posting the cartoon showing a guy with his tools in the vise, but decided not to go there. They've got theirs, we've got ours.

Trouble is, they still think they should be able to make critical decisions about our bodies. Do we make decisions about their health care? I think not. Except to try to get them to see a doctor for anything that might improve their health. Starting from Day 1.

Kathleen Eagle said...

Deb, I saw the ACS prez on another show making basically the same statement. We need to come up with better techniques, but right now, mammography is the best there is. We're doing much better than we were 20, even 10 years ago. Don't cut back. Don't allow insurance companies to cut back, which is what they'll do if we give an inch.

Kathleen Eagle said...

Marcia, right on about the ED drugs! It's not about what saves lives. It's about what brings in the cash.

Ever tried to explain those cialis commercials to a 5-year-old?

KylieBrant said...

I'm a rule follower, too. I have the annual tests. Had a scare the first time, have had a biopsy...I'm less scared knowing that I'm getting a good report than I would be if I waited two years to hear.

I think I read that they said the tests can cause problems. They are taking a hard look at all the xrays being done by dentists and doctors and finally saying what my dad has been saying for years...all those xrays can't be good for you. However, going once a year can't be that harmful.

I was very disappointed they came out with this. It's sort of like the AMA almost reversing themselves on letting babies sleep on their tummies last Aug. They're constantly weighing new evidence. But I'm not willing to be one of the percentage of acceptable risk they're willing to let die.

Call me cranky, LOL.

Kathleen Eagle said...

Absolutely, Kylie. The 1 in 1,900 makes all the difference if you're the 1. How can they say that 1 in 1,900 is an acceptable death rate and 1 in 1300 is not? Especially when that 1 is a woman in her 40's.

Insurance companies didn't start covering annual screening out of the goodness of their corporate hearts. A mammogram is a relatively inexpensive procedure, and it saves lives. Almost everyone who's been riding with us today has a personal experience or a close friend or relative to attest to that. Anecdotal evidence is powerful.


I've worked in insurance for over 30 years - if more women had mammograms and PAPs on a regular basis--more women would be able to avoid cancer and costs would be less. Period. The end.

My mother had a hysterectomy at age 39, and numerous fluid-filled cysts that needed aspirating (with a HUGE needle) all through her 40s and early 50s--until menopuase. Nothing was ever diagnosed as cancerous...until she was diagnosed with lung cancer at age 64.

I don't believe in coincidence, gals. Women who have "female problems," tend to have them. How soon is too soon to screen? Never, as far as I'm concerned.

And, as far as the guy versus gal thing: prostate cancer is much more treatable than breast cancer, right? And if it does require surgery, any disfigurement that might exist isn't visible to the whole world, right? Is it a coincidence that screening and treatment for prostate cancer is more advanced than that for breast cancer? You decide.

And what about EKGs? Did you know that 35% of women over age 35 have abnormal EKGs because the machines and testing were designed based on men's hearts--which are significantly larger than ours? (Only in size, not in other ways!) I learned all this the hard way--and have the EKG, stress test, and nuclear stress test to prove it. Along with the bills. Over $4,000 worth of "tests" to find out my heart is PERFECT? These are the test that cost money and make our insurance so expensive--the ones that should be redesigned to be more effective. Why don't they design testing for WOMEN'S hearts? And maybe a better screening test for breast cancer?


Thanks for listening to the rant. And thanks, Kathleen, for bringing this matter to attention. We need to talk about it. A lot.

Kathleen Eagle said...

Hi, Linda!

Wow. I've never heard that about EKGs. Thanks so much for the "rant." Really enlightening.

What did I tell you? This is exactly how women get to be so smart.

Lady_Graeye said...

No matter what the government's doctors say, the are my Ta-Ta's and I sure as heck going to take good care of them. If that means I get them smashed, twisted and pulled in various way to make sure they are okay and so am I.

robynl said...

I have yearly mammograms and am so pleased and thankful for that. In March/09 the test showed 2 lumps; one they were concerned about and had me get another Mammo and an Ultrasound. This led to surgery and a cancer result. Another surgery for lymph nodes and that was fine. Thank you so much for annual Mammograms. I had 25 radiation treatments which I finished a month ago.

Kathleen Eagle said...

I'm with you, Lady G.

robynl, thanks so much for telling us your story. You're on the road to recovery and proving the value of yearly screening. It's amazing how far we've come from what my aunt faced back in the 60's.

Laurie G said...

Every woman should be doing a monthly breast check. Know your body! Don't hesistate if you feel that you've found a lump..go to a doctor!! Also, if you have a history of breast cancer in your family, get regular mammograms!

A study is just a study, they can be interpreted in different ways, depending on who's paying for the study!

My girlfriend in college was diagnosed at the age of 29! No family history, just found a lump during a monthly self breast exam!!

Kathleen Eagle said...

Laurie, you make an excellent point. Women under the age of 40 can get breast cancer, too. A mammogram can detect a tumor before it's big enough to feel, but you're absolutely right--the monthly self exam has prompted many women to get themselves to a doctor as well. It's about awareness and resolve. Daddy's oldest sister knew she had a lump long before she sought treatment. By the time she went to the doctor, she was in terrible pain. Years later her younger sister ended up doing the same damn thing. Fear is a powerful instinct.