This week’s blog is serious. Please take a few minutes and click on the link above to read the New England Journal article on mammography in women between 40 and 50. Before you start reading, take a moment to recognize and acknowledge your biases. After you have read the article I’d like to discuss some of these issues with you. The issues that come to mind for me are breast cancer, cancer screening, women’s health, health care rationing, the health care crisis, the government’s role in health care decision making, technology and its limitations….there’s a lot to talk about.In order for an online discussion to take place, you have to use the comments area at the bottom of the blog. You can use your name or be anonymous. If this format works, we can use it to discuss other issues in upcoming weeks. If not, it was worth a try.
Some food for thought:
• In 2009, some 192,370 American women will be diagnosed with breast cancer, accounting for more than one in four cancers diagnosed.
• In 2009, an estimated 40,170 women will die from breast cancer; only lung cancer kills more women. This corresponds to 25 deaths per 100,000 women, down from 35 in 1989.
• Data from 2006 -- the most recent statistics available -- showed that about 2.5 million American women have a history of breast cancer. Most of these women were cancer-free. Others were still undergoing treatment.
• From 2002 to 2003, there was sharp decline in breast cancer rates, particularly for women aged 50 to 69. This reflects the drop in hormone replacement therapy by menopausal and postmenopausal women that began in 2002. Breast cancer rates have remained about the same since 2003.
• Since 1990, breast cancer death rates have dropped steadily. The decline has been greater among women under 50 (3.2 percent per year) than among women over 50 (2 percent per year).
• From 1997 to 2006, breast cancer deaths dropped by 1.9 percent a year among white and Hispanic women, 1.6 percent a year among black women, and 0.6 percent annually among Asian-American and Pacific Islander women. Death rates have stayed the same for American Indians and Alaska Natives.
17% of Congress are women.
Among uninsured women, only 30 percent had a mammogram during the past two years, compared with about 70 percent of insured women.
I am interested in what you have to say!
6 comments:
My mother, after finding a pea-sized lump in her breast, was diagnosed with breast cancer at age 42. She had no family history of the disease; she had a radical mastectomy which left her scarred and skeletal on her right side; I don't know if she ever regained a positive self image of herself after that hideous surgery. She died 2 months before her 49th birthday. She left 4 daughters and a son, ranging in age from 26 down to 12. My mother never saw any of us married; she never saw any of her grandchildren. We 4 daughters trembled when we turned 42, 43, 44, 45. Breast cancer targets the heart of families; cancer in any family member is felt by the whole unit, but in the mother, it is especially devastating. I started having mammography at age 30; I’ve had the follow-up studies which have, thankfully, given me good results. I’m happy to have the option to take action to treat the disease at an early stage, if I ever need to. If mammography is statistically ineffective in younger women from a cost-benefit ratio, then discontinue it BUT invest the money saved and develop a better screening test for early detection. Perhaps what starts seemingly as a step backward for women could end up as a giant step forward in development of new screening (blood) test for breast-specific cancer markers.
I could not help but notice that, right at the time that the government is trying to retool the healthcare system while containing the implied cost of such retooling, "scientists" are conveniently concluding that screening for women's health issues is less necessary than it used to be. Suddenly, we don't need mammography at age 40 and pap smears can become much more infrequent. Is it possible that the real underlying agenda is to offset the cost of national healthcare by shortchanging women? How quickly will insurance companies refuse to cover what used to be routine care? I am very skeptical about the "science" behind this new research. Cynic that I am, I am guessing we won't hear a real outcry until prostate exams and psa tests are not recommended anymore either.
Susan, I think that the science is very good and the study was commissioned well before the current crisis. The science behind PSA is much worse. Many MDs including oncologists won't even check it. Definitely not cost effective and leads to many questionable biopsies and surgeries. No proof that I know of that it saves lives. That's the problem: if a technology exists there is strong pressure to use it, proven or not.
Although I won't post my opinion regarding the necessity of mammograms, I will thank you for writing this blog in such a clutch time. I'm using the article you posted heavily in my research paper about women as a political demographic. Thanks!
Further reading, courtesy of Gallup:
http://www.gallup.com/poll/124463/Women-Disagree-New-Mammogram-Advice.aspx
Well, looks like I fit right in with the majority of women in the gallup poll cited by Brad: "A majority of women surveyed believe the panel made its decisions based primarily on the potential cost savings (76%) involved, rather than on a fair assessment of the true risks and benefits (16%) of mammograms for women in their 40s." Not that I generally think that the "mass opinion" is likely the correct one (since there are a lot of really dopey people out there), but it's interesting to me that the mass skepticism among women matches my own.
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