The New, Looming Battle Over American Womens' Breast Health

We haven't even finished the battle over Stupak-Pitts, but there's a new fight brewing. Monday's new recommendations on breast cancer screenings have finally saturated the media - and everyone from the GOP to Gail Collins is weighing in.

The report made waves by advising against home screening for breast cancer and against annual mammograms:

The task force, a federal advisory board, said this week that women should not begin routine mammograms until age 50, contradicting the well-established advice that women 40 and older should be screened.

Groups such as the American Cancer Society and Susan G. Komen for the Cure have opposed the new guidance.


The backlash was swift and merciless, forcing Health and Human Services Secretary Kathleen Sebelius to issue a statement saying that the recommendations of the task force are not guaranteeing a change in government policy:

In a written statement, Sebelius said the guidelines had "caused a great deal of confusion and worry among women and their families across this country" and stressed that they were issued by "an outside independent panel of doctors and scientists who . . . do not set federal policy and . . . don't determine what services are covered by the federal government." [...]

The task force on Monday recommended that women in their 40s stop having routine mammograms and instead individually discuss whether to get the exams with their doctors.

The panel also recommended that women in their 50s get mammograms routinely every two years, instead of annually. The panel argued that the benefits of more frequent exams were outweighed by the harms caused by false alarms, which can lead to anxiety and unneeded treatment.

While hailed by many patient advocates and breast cancer experts, the new guidelines have been harshly criticized by the American Cancer Society, the American College of Radiology and others, including some members of Congress.

Two of the women over at Time's Swampland blog are up in arms, noting that the recommendation seems more like a cost-saving measure rather than anything that will benefit women. Kate Pickert points out the numbers:

The panel also said a review of clinical data showed that yearly mammograms for women 40-49 reduced the risk of breast cancer death by 15%, but under a section titled "Balance of Harms and Benefits," said this:

  • Harms of screening include psychological harms, additional medical visits, imaging, and biopsies in women without cancer, inconvenience due to false-positive screening results, harms of unnecessary treatment, and radiation exposure. Harms seem moderate for each age group.
  • False-positive results are a greater concern for younger women; treatment of cancer that would not become clinically apparent during a woman's life (overdiagnosis) is an increasing problem as women age.

These new guidelines - which while influential, are not binding - have caused no small amount of consternation. Women are incensed that some faraway task force has decided a 15% risk reduction – i.e. actual lives saved – is not enough to warrant mass screenings. I asked a number of female colleagues here at TIME what they thought of the new guidelines and all said they found the new recommendations to be disturbing. One even said the news set off "a giant pink bell ringing in my head."

After pointing out how Congresswoman Debbie Wasserman-Schultz, a breast cancer survivor, freaked out at the proposal, Pickert concludes:

For instance, a small number of women get diagnosed with breast cancer in their 20s and 30s. Does this mean mammograms should be routine during these years too? At what point do lives saved outweigh "psychological harms, additional medical visits, imaging, and biopsies in women without cancer, inconvenience due to false-positive screening results, harms of unnecessary treatment, and radiation exposure." Will private insurance companies, which pay close attention to guidelines from the U.S. Preventive Task Force and other groups, stop covering mammograms for women under 50? Wouldn't insurers rather catch cancers early when they are easy (and cheap) to treat? And what about the oft-touted U.S. breast cancer five-year survival rate, which is 83.9%, compared to England, where it's 69.7%?


Time's Karen Tumulty doesn't pull any punches - she thinks the task force is composed of "pinheads:"

[A]t age 19, when I discovered lumps in both my breasts that didn't go away after a couple of menstrual cycles.

That's when I had my first mammogram. Back in those days, the technology wasn't what it is today, and it was inconclusive. My doctor decided he wanted to do a biopsy. That wasn't what it is today, either. A simple breast biopsy in 1975 required me to check in for an overnight stay in a hospital, and to sign forms before the surgery authorizing a mastectomy on the spot if it turned out to be cancer. I remember vividly waking up from the general anesthesia terrified, feeling the heavy layers of bandages trying to figure out what they had done. It was benign—thank God—but it turned out to be the first of several times I would go through this drill, because I have lumpy breasts. The fancy name for that is fibrocystic disease.

At the time of my first breast biopsy, I had no family history of the disease. I subsequently developed one. Over the years, my mom was diagnosed with breast cancer (and survived it); my aunt was too (and didn't). I've had a number of scares, but none, thus far, has turned out to be cancer.

So it would seem I'm the perfect example of a person who shouldn't have had mammograms, or even examined my own breasts. But am I sorry I've had the information I've had through mammograms and self-exams? Not for a second.

That's why I think these scientists are pinheads. Pink ribbons are lovely, but women who want information should have it. And I would remind Swampland readers of the important lesson we all learned from Carly Fiorina. Information is power, ladies, and don't let some scientific panel tell you it isn't.


But the NY Times' Gail Collins begs to differ:

Somewhere between the reports that Pap smears and tests for prostate cancer aren't all they were cracked up to be and the news that a high fiber diet doesn't do anything to prevent cancer, the health establishment began looking decidedly nonomniscient. Then this week, a federal task force reported that most women don't need annual mammograms.

Even more fascinating, they suggested that doctors stop telling their female patients to self-examine their breasts for lumps. [...]

The report triggered two immediate and inevitable responses. Doctors and patients began an animated discussion. And Republicans declared it was all a Democratic plot.

"I mean, let the rationing begin. This is what happens when bureaucrats make your health care decisions," said Representative David Camp, the ranking Republican on the House Ways and Means Committee.

Representative Camp is definitely on to something. Whatever happens, we do not want the government conducting any studies on whether current health practices actually do any good. Let this continue and soon you will not be able to get your hands on a good leech when you need one.

There is no possible political advantage in coming out against medical testing, so the Obama administration scurried away from the report. The task force did not consider the matter of cost, but, of course, people like Representative Camp depicted it as the first step toward rationing. The current position of the Republican Party seems to be that it is not possible to spend too much money on medicine. Party on.

(Has anybody noticed that the people who darkly warn about government bureaucrats forcing insurance companies to cut back our coverage appear to be the same ones who just voted to force insurance companies to stop covering abortions? Where's the sanctity of the marketplace when we really need it?)


Collins, also a breast cancer survivor, is remarkably glib about the whole business, explaining:

I had mammograms every year like clockwork, and I had just gotten a clean bill of health from my latest one when I found a lump on my left breast while watching a rerun of "Buffy the Vampire Slayer," multitasker that I am.

It turned out to be cancer, of a fairly low-grade variety. My oncologist felt strongly that it never would have developed if I hadn't taken estrogen replacement therapy - another one of the medical marvels that has now been consigned to the Seemed Like a Good Idea at the Time category.

So, in summary, the cutting-edge of medical thinking of the 1990s may have induced my cancer, and then the universally recommended testing protocol failed to detect it.


So who's correct? Only time will tell, but in terms of personal health, most of us would prefer to side with the old adage "an ounce of prevention is worth a pound of cure."

Who decides about mammograms? Inside the task force [CNN]
Sebelius distances herself from new mammogram guidelines [LA Times]
Are Mammograms the New Political Football? [Time]
A Word About My Breasts [Time]
The Breast Brouhaha [NY Times]


Earlier: New Breast Cancer Screening Guidelines Spark Confusion, Criticism



Perhaps this will come across as glib or paranoid, but I feel that moments like this (and many of the experiences the Jezzies have shared about their medical procedures/visits) highlight how little funding and attention is paid to women's health over all. There is always conflicting information, doctors who are well trained and yet clueless, and a general distaste/disinterest within the powers that be for the advancement of women's health studies and the protection of women in society. It difficult for women to trust science. And it blows my mind that a developed and wealthy nation is in anyway considering measures that would prevent the prolonged health and longevity of their female (and frankly essential) population.

I found out few a days ago that an ultrasound can pick up what a mammogram cannot. Yet ultrasounds are not routinely used. So one could conceivably double up on a chance to detect and yet this is not done.