Bad Medicine Part I: Womens Health

So, I thought I would put in my two cents about some hot topic health news. Obviously this is simply my non-expert advice, so feel free to take it with a grain of salt...or two, and I'll try to support my soap box with some facts :)

Breast Cancer

First of all this is a hot button issue for a couple of reasons. Breast cancer is a fad right now and for good reason-it is the most common cancer in women AND it is the number two killer (behind lung cancer). Recently, the United States Preventative Services Task Force came out with a new recommendation that said that women under the age of 50 who are not at a high risk for breast cancer should not get regular mammograms. They also suggest that women should not give themselves monthly breast exams. This goes against the current general best practice guidelines which state that every woman should have mammograms every 1 to 2 years after the age of 40, and that women should be taught perform breast exams once a month. Both the American Cancer Soceity and the Susan G. Komen foundation have spoken out against the panel's recommendations. A couple things to consider:


     a. The task force is "An independent panel of experts in primary care and prevention that systematically reviews the evidence of effectiveness and develops recommendations for clinical preventive services". It is a subsidary of the U.S. Department of Health and Human Services but it does NOT set federal policy. The task force consists of MDs, RNs, MPHs among others. They gathered their information from a panel of cancer experts including oncologists, oncology surgeons and researchers but none of these professionals made the final recommendations. This task force simply acts to provide recommendations for clinical practices but does not actively change policy or practices.
    b. So, you're probably asking yourself why in the world this panel would make these recommendations. The incidence of cancer in women below the age of 50 is relatively low. About 40, 000 women are diagnosed each year in this age group; so for every 1, 000 mammograms performed 2 will detect real cancer. Their main reasoning it seems is that mammograms are stress-inducing, expensive and expose women to low levels of radiation for what could be no "good" reason. Remember those 2 cases of cancer found per 1, 000 mammograms? In addition to those 2 cases of cancer found, 98 will yeild "false positives." Essentially, many of the findings of mammograms lead to biopies which turn out to be harmless, which means that you go through a lot of worry, pain and money for something which turns out to be benign. In terms of the recommendation about self-breast exams, they say that most women find lumps which turn out to be benign which induces stress and doctors visits, i.e. more money. Bottom line, they say that mammograms and self-breast exams are not effective at preventing breast cancer (no shit Sherlock, its a screening tool not a preventative measure...sorry cynicism contained).
   c. Keep in mind that these recommendations do not apply to women who are deemed to be at an ultra "high risk" for breast cancer. You are high risk if you are known to have the BRCA-1 or BRCA-2 genes or have two or more first degree female relatives who were diagnosed with breast cancer (early-onset is thought to be the genetic version). These women should have their first mammogram 5 years before the age of the youngest diagnosed (follow me?).


As with most things, I think that the media is not presenting this case in the right light. I think the task force is trying to say that yearly mammograms might not be right for every woman and that American women should sit down with their providers and have a discussion about how they are going to approach breast health and breast cancer prevention. Unfortunately the road to hell is paved with good intentions and the backlash from this could be devastating to the progress breast cancer advocates have made in the past few years. There are a few things which could happen, women could just stop getting mammograms or (a more likely scenario) the evil insurance companies could use this as leverage to stop covering mammograms for women under the age of 50. Some people say this is likely others say it is not...only time will tell but I think its something worth worrying about.


The bottom line here is that you all need to take control of your health. Self-awareness is that first step to maintaining good health. I believe that this includes self-breast exams. There is nothing wrong with knowing your bodies and for pete's sake its free. Perform them once a month on the same day and do it both lying down and standing up. The key here is to know your body, know your baseline and you'll know when something is up. Next, examine your life style and your breast cancer risk factors, and if you think that mammograms every year are important to your health goals then push your insurance companies and your providers to incorpoate this into your plan of care. On a final thought, I understand that mammograms are expensive and an imperfect science, but they are certainly not obsolete. Just ask all those women (and their families) who are diagnosed with or die from breast cancer each year. Researchers need to produce a very clear message and, most importantly,  they need to be dead-rock certain of things before they go making generalizations which induce a media storm. So maybe its not bad medicine but it is reckless.