I am quite opinionated, although I haven’t voiced those opinions on this blog since that idiot from Alaska insulted me with her unending presence on television. I am a struggling writer, and I derive much of my inspiration from current events. I must weigh in on the mammogram controversy, or, as I like to call it, “How 16 ‘Experts’ Became My Insurer’s Best Friends.”
As everyone now knows, a federal advisory board has issued a new recommendation on mammograms—put bluntly, the board rescinded the prior recommendation that women in their 40s should get mammograms yearly (or every other year). Instead, the board now recommends that women 50 and older get mammograms every two years.
Breast cancer afflicts hundreds of thousands of women every year. Chances are, you or someone you know has suffered from the disease. It is common knowledge that the rate of mortality for the disease significantly decreases if the disease is caught in its early stages—and one of the most effective tools to that end is the mammogram. Indeed, as acknowledged by the board, “Breast cancer is the second-leading cause of cancer death among women in the United States. Widespread use of screening, along with treatment advances in recent years, have been credited with significant reductions in breast cancer mortality.”
So why, then, is the board suddenly turning a 180 on early screening—when that very screening reduces mortality? Well, the board apparently is primarily concerned about a woman’s psychological well-being. From the report:
The harms resulting from screening for breast cancer include psychological harms, unnecessary imaging tests and biopsies in women without cancer, and inconvenience due to false-positive screening results. Furthermore, one must also consider the harms associated with treatment of cancer that would not become clinically apparent during a woman’s lifetime (overdiagnosis), as well as the harms of unnecessary earlier treatment of breast cancer that would have become clinically apparent but would not have shortened a woman’s life. Radiation exposure (from radiologic tests), although a minor concern, is also a consideration.
Let’s examine the secondary concerns, namely “overdiagnosis,” “earlier treatment” and “radiation exposure.” These concerns exist independently from the efficacy of a mammogram. In other words, the issue the board appears to have is not with the ability of the mammogram to detect cancer—rather, they fear that some health professionals may take an overly aggressive approach after seeing ambiguous signs of cancer through a mammogram. If the issue is with the risk of an overly aggressive assault on maybe-cancer, then the board may be warranted in issuing recommendations on those procedures, not the mammogram itself.
The primary concerns, however, have to do with the board’s incredibly patronizing views regarding a woman’s psychological well-being. Namely, the board does not want to subject women in their 40s to “unnecessary imaging tests” and “unnecessary . . . biopsies” and “inconvenience.” The board doesn’t seem to dispute the fact that breast cancer is frequently diagnosed in women in their 40s. Rather, the board seems to be saying that not enough women in their 40s are diagnosed to justify the necessity of mammograms, so to avoid the psychological strain of having mammograms, let’s just do away with them altogether until you’re in an even higher risk group. Well, I think that the members of this esteemed board (none of whom, by the way, are oncologists), can suck it. When I’m 40, if I want to endure the psychological turmoil of having my boobs pressed like a panini so I can avoid death by breast cancer, I’m going to do it. I understand there are false positives. My damn doctor has told me about the risk of false positives. I can handle that. You know what my mental health cannot handle? Waiting until I’m 50 to get a mammogram and hoping that the cancer has not already afflicted my boobs (or lymph nodes—don’t forget those, ladies), like it has hundreds of thousands of women before me in their 40s. Alternatively, my mental health can’t handle my insurance company quoting your recommendation and rejecting my claim because my mammogram is medically “unnecessary.”
So for the esteemed 16 members of this board, sleep easy knowing that millions of women (and their boobs) think you suck, but at least the insurers love you.