I’m a woman whose life was saved by a mammogram.
And yet, I find myself in the interesting position of supporting – reluctantly, unenthusiastically, but still supporting – new guidelines released yesterday by the U.S. Preventive Services Task Force regarding screening mammograms.
Guidelines that, had I followed them 8 years ago, probably would have resulted in my death.
How can I possibly support the USPSTF’s position?
Because I’ve lived long enough to realize that the U.S. government, while it’s “by the people and for the people,” sees “people” in the aggregate – as statistics, not personalities.
We’re not mothers, or daughters, or lovers. We’re numbers. Variables in an equation.
And after studying the numbers, government doctors and scientists have decided that the cost-benefit equation for regular screening mammograms before the age of 50 doesn’t add up.
Too much cost; not enough benefit.
According to a story in yesterday’s New York Times, USPSTF vice chairwoman Dr. Diana Petitti noted that the new guidelines are “aimed at reducing the potential harm from overtreatment.” Adding that she expects a firestorm of reaction, she said, “We have to say what we see based on the science and data.”
Dr. Donald A. Berry is a statistician at the University of Texas M.D. Anderson Cancer Center, and head of one of the USPSTF’s modeling groups. He said yesterday that in the aggregate, women get very little help from regular screening mammograms before age 50, or from yearly mammograms after age 50. “So little,” he added, “as to make the harms of additional screening come screaming to the top.”
And what are these “harms of additional screening?”
According to the USPSTF, the psychological anxiety and expense attached to negative biopsies. About 85% of biopsies for breast cancer – the vast majority of which are spurred by mammogram findings – show no cancer.
And the cost and pain of treatment for stage 0 breast cancer (in situ, non-invasive cancer). Many researchers feel that even without treatment, the majority of such cancers would remain dormant throughout a woman’s lifetime, never threatening her health.
Then there’s the financial cost. Billions of dollars will be saved on screening and treatment if these new guidelines are followed. And let’s not be disingenuous here; the bottom line is where it’s at, for many of our lawmakers.
Fran Visco, president of the National Breast Cancer Coalition, supports the new guidelines. “These are the people we should be listening to when it comes to public health messages,” she said.
As does Dr. Susan Love, perhaps the country’s most celebrated breast cancer doctor, who says they make sense as a matter of public policy.
Love, interviewed this morning on National Public Radio, advocated for money spent researching the causes of breast cancer, rather than its identification and treatment.
The USPSTF’s research shows that one cancer death is prevented for every 1,904 women age 40 to 49 who are screened for 10 years. That’s over 19,000 mammograms to save one life.
Was I worth it?
To my son and husband, my family and friends, yes. To the many women I’ve helped on this site, probably.
To the U.S. government? No.
Are we more interested in saving money, or in saving lives? The official, governmental answer, as of this morning, is saving money.
I don’t like the answer. It literally makes my skin crawl.
But I support the government’s right and responsibility, via the USPSTF, to come to that conclusion.
Reluctantly. Unenthusiastically. And with great pain in my heart for the women who will follow these new guidelines, and die of breast cancer – cancer that would have been identified and treated under the old guidelines.
Anjali: PJ Hamel on NPR
Phyllis Johnson: Risks and Benefits: Understanding the Statistics that Affect You
Maimah Karmo: The "Gods" Must Be Crazy
Moderator's Note: I would just like to take a minute here to remind everyone that even though this is a hot-button issue, things need to stay civil. We are not asking that you agree with PJ, simply that if you disagree, you do so in a respectful manner.
Published On: November 17, 2009
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