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Outrage over new mammogram advice is misplaced

I expected some controversy and debate about the U.S. Preventive Services Task Force’s new recommendations about breast cancer screening, but nothing as virulent as what has occurred over the past few days.

Nor did I anticipate the rampant, breathless fear-mongering rhetoric that has framed much of the media’s response to the recommendations.

Press reports around the country, especially TV ones, seem to have focused primarily on individual women and doctors who are “outraged” about the recommendations (which essentially say that women who are not at high risk for breast cancer can wait until age 50 to begin screening mammograms, and that even then, getting a mammogram only every other year is fine).

On ABC’s daytime talk show “The View,” co-host Elisabeth Hasselbeck made the stunning claim that the recommendations were “gender genocide.”

Gender genocide? Really? (More about that in a minute).

Politics, alas, rears its head
People opposed to national health-care reform quickly jumped on the recommendations as “the first step toward that business of rationing care based on cost” (Rep. Phil Gingrey, R-Ga.).

Rep. Sue Myrick (R-N.C.), a breast-cancer survivor, is quoted in the New York Times as saying she didn’t think a government commission “should be engaged in decisions like this between a woman and a doctor.”

“My concern,” she added, “is that we’re basically sending a message that you don’t have to take care of yourself when we’re trying very hard to do prevention in this country.”

Cost wasn't a factor
Let’s clear up some things. First, the U.S. Preventive Services Task Force is an independent group of physicians and academic experts, not a government agency that makes policy. And, indeed, as Kathleen Sebelius, secretary of the U.S. Department of Health and Human Services, said in a written statement issued Wednesday, “The Task Force has presented some new evidence for consideration but our policies remain unchanged.”

Sebelius suggested that women “keep doing what you’ve been doing for years — talk to your doctor about your individual history, ask questions, and make the decision that is right for you.”

Second, the task force recommendations state quite clearly that the decision about screening mammography before age 50 “should be an individual one and take into account patient context, including the patient's values regarding specific benefits and harms.”

Oh, and for the record: The task force specifically did not factor the cost of screening into their recommendations. The recommendations are based on the latest scientific studies. That's all.

Don’t worry your little head?
A lot of the fear-mongering about these new recommendations has centered on the idea that somehow they’ll “confuse” women — that we women won’t understand what to do with this news and therefore might, heaven forbid, make the “wrong” decisions. (Listen carefully to the doctors on this Wednesday segment of ABC’s “Good Morning America” show and you’ll hear that patronizing message under much of the discussion.)

Give me a break. I want as much information as I can get — no matter how “confusing” or scientifically complicated and nuanced it is — when I make decisions about my personal health.

Remember the non-nuanced advice women got for decades about menopausal hormone replacement therapy? I’d rather weigh the information myself, thank you very much.

And then there’s the narrative — perhaps most pointedly made by Hasselbeck’s “gender genocide” comment — that somehow these recommendations are evidence of forces in the medical community (and in the government) that are willing to sacrifice women’s health to save a few bucks.

Again, give me a break. First, there’s nothing new about this mammography debate. And among the people who have been raising questions about this issue the longest are some of the greatest advocates for women’s health — groups like the National Women’s Health Network (NWHN), which first raised doubts about the value of mammography screening in women under age 50 back in 1993.

Here’s what Cynthia Pearson, long-time executive director of the NWHN, wrote on the organization’s website Tuesday:

We’re glad that the [U.S. Preventive Services Task Force] has done what they’re supposed to do. They’ve told the truth about what studies have found, and now women have a better chance of getting an honest assessment about the value of a heavily promoted technology. Information is always a good thing and we’re glad more women now have access to good information.
But, I’m not at all happy today. Not even to be proven right about things that I took a lot of criticism for saying. Rather, I’m outraged. We’ve known for 16 years that mammography screening doesn’t work well for women before menopause, and not at all for women under 40. And at the same time, we’ve known that a significant number of breast cancer cases occur in women under 50. So once we knew mammography wasn’t good enough, the next step was obvious – we need to find something better.

Too bad that her outrage isn’t getting heard in the media.

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Comments (4)

The creepy thing is that they say they're making a 'population' recommendation rather than an 'individual' recommendation.

That's what happens when you take away health decisions from the individual and put it in the hands of the government. It all becomes a 'population' decision.

I would be curious to know if the women on the panel would still get mammograms if they were in their '40's or would they follow their own 'population' recommendation. I am sure they would make an 'individual' decision and get one.

Susan Perry: Thank you for this well-reasoned response to the media hysteria surrounding this issue. Breast Cancer Action also has a supportive analysis of the new, evidence-based recommendations on their website http://www.bcaction.org/.

Rep. Sue Myrick conflates "prevention" with detection - not the same thing at all. Mammography won't prevent breast cancer.

In the United States, the conversation about actual prevention is so marginalized that our culture fails to be outraged at the minimal progress on that front while we clamor for detection that is not even working.

And, Myrick continues to put the burden back on women - "take care of yourself" - for a largely industrial problem.

The intense opposition to these new recommendations illustrates why it's going to be so hard to bend the cost curve on health care. People cling to the sense of security these tests provide, even when empirical evidence shows them to be ineffective.

Of course, the new guidelines were an unlooked-for gift to the opponents of health care reform, who decried them as a harbinger of government rationing of services. These are the same people who claim to oppose reform because it's too expensive. Go figure.

I do think the media could have explained the rationale for the new guidelines more clearly. My understanding is that at heart they're based on evidence that "early detection" is not all it's cracked up to be. Especially in younger women, aggressive cancers are not caught in time even with regular mammograms (which are notoriously less reliable for younger women), frequent false positives result in unnecessary and anxiety-producing follow-up tests and biopsies, many tiny cancers that would never cause trouble are over-diagnosed and over-treated, and other cancers, even though discovered later, are nevertheless treated successfully without mammograms.

I've read a lot about the supposed sinister cost-saving motives behind the new guidelines (the panel was specifically instructed NOT to consider cost) but nothing about the huge economic interest in preserving the status quo. Radiologists and imaging centers are staffed and equipped based on the existing guidelines. Consider: a woman who follows the current guidelines and lives to age 78 will have almost 40 mammograms in her lifetime. Under the new guidelines, where mammograms begin at 50 and occur only every other year, the same woman will have fifteen mammograms. Do the math. The economic impact on providers of mammography services would be enormous.

Hi Susan,

Great column. In all the coverage I've watched, no one from the NWHN has ever been included on the panels of talking heads - what a shame. I hope they are able to wedge themselves more into the national debate -- more so than Elisabeth Hasselbeck (actually, it would be wonderful if someone NWHN could get on the View to debate Hasselbeck's misinformed view).

My favorite quote so far has been from Dr. Northrup (posted on her Facebook page): "Our culture uses mammograms as a fix in the mistaken belief that this test can create breast health. But true breast (and heart) health comes from living lives in which giving and receiving are equally balanced and in which we eat well and move our bodies joyfully, vigorously, and regularly."

Another good doctor response comes from Dr. Dixie Mills (former colleague of Dr. Northrup and still practicing at Women to Women in Maine): http://www.womentowomen.com/breasthealth/annualmammogramscreening-update...

Reasonable voices are out there! Even if we have to dig a little to find them. Thanks Susan, for highlighting the NWHN!