Another Mammogram Voice

I feel compelled to add my voice to all the others talking about mammograms.

I spent years married to a radiologist who did nothing all day but diagnose DCIS and other cancers. He prided himself on his ability to diagnose ductile carcinoma in situ, and he thought he was saving lives. He didn’t know that many of those never progress, and in fact go away. He died before digital imaging became the norm, and he started to practice before doctors appreciated the dangers of overexposure to radiation. Like many radiologists, he died of cancer.

So my thoughts about mammograms are very complex. I’ll try to sum them up.

1) in America, we overdiagnose many diseases and treat things that don’t need to be treated.
2) medical knowledge is constantly changing
3) most medical knowledge is merely opinion
4) suggesting that we now overexpose women to needless radiation and biopsies isn’t rationing — it’s sound science for today
5) breast cancer and prostate cancer have something in common: they subject men and women to assaults on their dignity and sexuality, sometimes for nothing
6) men and women should be able to make their own choices about screening, so I’m glad insurance is still going to cover mammograms for women in their 40s
7) even my husband used to say that mammograms were not as good at detecting cancer as other forms of imaging for high risk women

See how complicated this is? It’s unfortunate that the panel of “experts,” which apparently didn’t have a breast cancer expert on it, released this while we are debating health care reform. It’s easy to see this new guideline as a way to ration care under “Obamacare.” Between this and the Stupak amendment, it is easy to draw the conclusion that we’re bending the cost curve over the backs of women.

But again, it’s complex. We’ve found out the same things about prostate cancer screening, so it’s not just about women. This is what is known as “evidence-based medicine” : let’s spend the money on things that do work, rather than pitch it away on things that don’t. That makes sense, doesn’t it? Why waste scarce health care dollars. Let’s only do things that are proven to work.

I’m a fan of outcomes-based medicine. I long ago learned that most back surgeries don’t work (for long), and that surgeons sell surgery as a panacea the way pharma sells drugs as a panacea. If we were spending our own money, and not the government’s or an insurance company’s, believe me we’d be finding out the most effective (and cost-effective treatments) before we authorize anything. It’s only because medicine is mostly paid for by third parties much removed from ourselves that we demand everything.

I don’t have the answers. I just want to raise the right questions, and keep us talking rationally instead of degenerating into ideological rants about science-based findings.

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Tagged as: health care reform, mammograms, rationing, women's health

physioprof

Thank you for your informed comments. Risk management is an informed woman's choice. We need all the information we can have to make decisions about our bodies.

I am asthmatic, and a member of the generation that received many childhood chest xrays -when radiation doses were much higher. I worked with radioisotopes as a grad student. In my 40's and 50's I received many cervical spine xrays, and needed to get pretty assertive about chest protection. I have often needed to ask for a lead apron during dental xrays. If my breasts aren't exposed to radiation at all from the proceedure, why do they need to leave the room. I had a baby at 18 and breast fed. I do not smoke. My alchohol intake is very low. I use olive oil for almost all ingested oils. I am low risk for breast cancer — except possibly something due to total lifetime radiation exposure. No doctor would ever tell me that there was zero risk for mammogram radiation. And I asked.

If I had a baseline at 40, and a mammogram every year up to 80 – that would be 40 exposures to radiation. No physician was ever able to tell me that that much total radiation would not increase my risk of having breast cancer in my 70's or 80's.

I decided in my 40's to have a baseline masmmogram at 50, and one every two or three years there after – unless information or technology changed.

I had one false positive. The suspicious 'lump' was in breast tissue that bordered the axillary region. The team doing the X-ray guided routine tissue collection, had trouble positioning my 'lump'. I finally asked them to let me position my self and they were able to collect the tissue sample without surgery. This was a painful and difficult process due to the location of the 'lump', and my cervical and lumbar fusions. I don't know the radiation dose I was exposed to as they tried to get the instruments to reach the shadow on the screen. It turned out to be a lymph node. I am greatful. If needed, I will go through this procedure again. But I do not want to irradiate my breasts any more than necessary. False positivesd are not just extra cost – and to be honest I am not as concerned about extra cost as I am concerned about the extra radiation, pain, and anxiety that may follow a false positive.
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physioprof

Thank you for your informed comments. Risk management is an informed woman's choice. We need all the information we can have to make decisions about our bodies.

I am asthmatic, and a member of the generation that received many childhood chest x-rays -when radiation doses were much higher. I worked with radioisotopes as a grad student. In my 40's and 50's I received many cervical spine x-rays, and needed to get pretty assertive about chest protection. I have often needed to ask for a lead apron during dental x-rays. If my breasts aren't exposed to radiation at all from the procedure, why do they need to leave the room. I had a baby at 18 and breast fed. I do not smoke. My alcohol intake is very low. I use olive oil for almost all ingested oils. I am low risk for breast cancer — except possibly something due to total lifetime radiation exposure. No doctor would ever tell me that there was zero risk for mammogram radiation. And I asked.

If I had a baseline at 40, and a mammogram every year up to 80 – that would be 40 exposures to radiation. No physician was ever able to tell me that that much total radiation would not increase my risk of having breast cancer in my 70's or 80's.

I decided in my 40's to have a baseline mammogram at 50, and one every two or three years thereafter – unless information or technology changed.

I had one false positive. The suspicious 'lump' was in breast tissue that bordered the axillary region. The team doing the X-ray guided routine tissue collection, had trouble positioning my 'lump'. I finally asked them to let me position myself and they were able to collect the tissue sample without surgery. This was a painful and difficult process due to the location of the 'lump', and my cervical and lumbar fusions. I don't know the radiation dose I was exposed to as they tried to get the instruments to reach the shadow on the screen. It turned out to be a lymph node. I am grateful. If needed, I will go through this procedure again. But I do not want to irradiate my breasts any more than necessary. False positives are not just extra cost – and to be honest I am not as concerned about extra cost as I am concerned about the extra radiation, pain, and anxiety that may follow a false positive.

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