One of the most fascinating/confounding phenomena I’ve observed over the last decade is the absolute explosion of health information on the web and the profound impact it can have, both positive and negative, on people’s behavior, attitudes and healthcare choices. While there’s definitely a lot of good information out there, there’s also a lot of bunk. Sifting through the clutter, picking out the important nuggets and turning them into choices about our health has become a huge challenge, much more so in a time when medical and scientific innovation is being communicated directly to consumers through so many different channels. In this monthly column, I’ll be cutting through the health-web BS and translating internet-speak about bodies, fitness and nutrition into real talk that matters for your health. Join me as I try to make sense of it all — I’ll do my best to tell it to you straight.
Everywhere you look on the internet these days, someone is telling women what to do with their boobs. A lot of time and energy seems to be focused on where we can bare them and when, whether it’s to feed hungry baby humans or less necessary/humanitarian endeavors such as entertaining tourists in Times Square. Everyone seems to have an opinion on what women should or shouldn’t do with their boobs, but when it comes to breast health, the opinions have become more and more confusing.
This statistic has become sadly apparent as I get older; there isn’t a single person I know that doesn’t know at least one woman who’s had it or is fighting it or worse. It’s frightening and devastating all at once.
Despite the statistics and the harsh reality of breast cancer, some women are choosing to forego the gold standard screening measure for breast cancer: mammograms.
Mammograms were widely adopted as a breast-cancer screening test in the mid-80s. As a direct consequence, U.S. deaths from breast cancer have dropped 35% and clinical guidelines have recommended yearly mammograms for women over 40. Until now. In May of this year, the U.S. Preventative Services Task Force (USPSTF) released updated guidance recommending a biannual mammography screening for women ages 50-74. For women in their 40s, the USPSTF stated that the decision to get a mammogram is “a personal one,” despite recent studies which show that women in their 40s who received mammograms annually are diagnosed earlier with smaller tumors and are less likely to need chemotherapy to treat their cancer.
More and more, we’re experiencing this kind of perplexing conundrum when it comes to the interpretation and dissemination of clinical guidelines.
What is this “task force” you might ask? Well, in 1984 the government put together the USPSTF, a “group of national experts” to develop clinical recommendations independently of private interests. Fair enough you might say, we should totally have that. But there’s more. One of the most important functions of the USPSTF is to assign “grades” to preventative health services such as cancer screens. And here is where the plot thickens. Under the Affordable Care Act (ACA), private insurers are only required to cover preventive services if they have an “A” or “B” grade from USPST. The new USPSTF mammogram guidelines give a “C” rating to screening for women ages 40 to 49, which calls into question whether mammograms will continue to be covered by insurance. This, of course, has set off a flurry of opposition from foundations and professional organizations including Komen and the American College of Radiology and has left health-care providers scrambling to address patient concerns.
Meanwhile, we are now in a situation where the American Cancer Society recommendation — that women age 40 and older should have a mammogram every year and should continue to do so for as long as they are in good health — is in direct opposition to that of the USPST. When a government-assembled team meant to lead national preventative care guidelines and the largest private nonprofit funder of cancer research in the United States can’t get on the same page, where does that leave us, the women with boobs (and families and jobs) to take care of? Should you get that mammogram or not?
More and more, we’re experiencing this kind of perplexing conundrum when it comes to the interpretation and dissemination of clinical guidelines. The foundation of this and other healthcare debacles (see gluten cast as the destroyer of gut health, autism blamed on vaccines, vaccines being bad and un-natural) is a combination of the misunderstanding or cherry-picking of scientific data coupled with logical fallacies being disseminated at web-speed to the point that the collective “we” doesn’t know how to keep up.
One of the prevalent views fueling opposition to mammograms in the last year has been the idea that the test can lead to over-diagnosis and overtreatment of breast cancer. What does that mean? Over-diagnosis in the context of cancer is problematic to define. A certain proportion of cancers identified through mammography will not develop into aggressive tumors, but guess what? There is no way to know that when the cancer is first identified. This is the scary thing about cancer — you don’t know which way it will go. Will it be aggressive and metastasize everywhere and kill you? Will it be slow-growing and just sort of fester there forever? Will it go away on its own? If it’s your breast, do you take the chance?
More insipid are the appeals to detract women from getting mammograms because of the emotional turmoil that it may cause to get a false positive result. If there were a better alternative that could eliminate false positives I would sign up for that in a heartbeat. But there isn’t.
As of today, there is no substitute and no replacement for a mammogram. If the choices are a week of stress vs. a potentially deadly disease, it tends to shift your perspective. The worst part of “boob-gate” is that we seem to be promoting a lack of vigilance. Is it pleasant to have your boob squished as it needs to be during a mammogram? No. Do I wish there was something better? Yes! Perhaps rather than dissing mammograms we could spend a little more of our energy calling for innovation in diagnostics and treatments for breast cancer and for getting off our collective asses to prioritize women’s health on the whole. Until there is a better solution however, this is what we have to work with.
So what should you do?
- Talk to your doctor. You know those professionals that spend 100 years in post-secondary education that are supposed to help you with your health? Talk to them. Go to your appointment with a list of questions, concerns and fears, and don’t leave until you have addressed every last one of them. Ask for reliable resources for self-education.
- Check your own boobies. Get familiar with them, do the self-check. You are your own first line of defense, so you need to trust your own knowledge of your body and take care of it.
- Get others involved. Who knows your boobies almost as well as you do? Those lucky enough to get to squeeze them on a regular basis. Talk about breast cancer with your designated boob-squeezer, take the stigma out of it, hell, make it part of your sex-life. (And to all you lovers out there: If you feel something, say something.)
- Make a choice. The worst thing any of us can do is to pretend that breast cancer can’t happen to us. One in eight, people. We are, despite efforts to make it otherwise, still in charge of our own bodies. Even as it becomes increasingly difficult to separate scientific proof from opinion when it comes to healthcare, we still need to make choices. For me, that means getting checked every which way I can, mammograms included.
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