Well, well, well, here we go again. Wasn’t it just a few months ago that the big controversy over whether or not women should get mammograms raged? All that stuff about how many lives it saved, vs. how much unnecessary treatment it produced, due to false positives? And now the United States’ largest medical specialty group, the 120,000-internist American College of Physicians, has issued new guidelines that urge women in their 40s to speak to their doctor about whether or not to have a mammogram, rather than just going ahead and scheduling one every year or two.
On the face of it, this sounds sensible. Sure, when you hit 40, ask your doctor if a mammogram should become part of your regular yearly physical. He or she might answer in the affirmative, or suggest every other year, if there’s no history of breast cancer in your family, and you don’t present any of the common risk factors. But then again, the doctor might be one of those 120,000 internists who seems to think that the possible harmful effects of mammograms for women in their 40s might just outweigh the benefits. “We agree that mammography can save lives,” said Douglas Owens of Stanford University, speaking for the group that wrote the guidelines. “But there are also potential harms. We don’t think the evidence supports a blanket recommendation.”
And what does the evidence show? That regular mammography reduces the breast cancer death rate for women in their 40s anywhere from 15% (the currently accepted figure), to 0%, to more than 15%–the data at this moment isn’t complete nor clear enough to be more exact than that. Some researchers characterize the benefit of mammography for women in their 40s as “marginal.” Others note that mammograms can also miss some cancers, leaving some women falsely reassured. (So, let me get this straight: because there’s a slim chance the car might break down on the way to the supermarket, we should never drive the car at all?)
OK, to be fair, the ACP makes some good points–on paper. Leaving emotions aside, looking purely at statistics and data, there are probably an unacceptably high number of women who undergo treatment–repeated mammograms, biopsy, radiation, surgery, even chemo–needlessly. Women are suffering–needlessly. Insurance companies are paying out money–needlessly.
But let’s take our eyes off the greenbar for a moment and look at the real face of all this data: the human face. If women in their 40s stop getting mammograms as a matter of course, there will be many fewer who go through needless treatment. There will also be many more who’ll die. Where’s the balance in this equation? For every woman in her 40s, dead of breast cancer because she didn’t have a mammogram, there’ll be X number of women who didn’t have to worry about a false positive. For every young child left motherless, every husband left without his wife, there’ll be X amount of time saved by women who didn’t have to do radiation. And for every mother who watches her daughter die before her… Does it ever make sense to condemn one group of women to death, so that another group doesn’t have to suffer a bit of pain, go through some inconvenience, or worry for a few days?
Maybe I’m taking this too personally. But to me, this subject is VERY personal. Had these guidelines been out there 5 years ago, and had I followed them, I’d be dead today. I wouldn’t be writing these words; you wouldn’t be reading them. My son would have lost his mother; my husband, his wife; my parents, their daughter. I thank God every day I had a mammogram at age 47, because it saved my life. Repeat that story by x-thousands of women, and THAT, my friends, is the very human side of the new guidelines issued by the American College of Physicians.
Published On: April 03, 2007