Dr. Nancy and the REAL reason mammograms need to be limited

[Robyn66]

I wish there were transcripts to the Today Show segments but here is a link to the page where you can find most of them

http://today.msnbc.msn.com/id/21839940

If you watch them you will see that she disputes a member of the American Cancer Society who disagrees with the science behind the findings of the panel and in several of the videos talks about how it just isn't cost effective for women to get mammograms from the age of 40. And she admits that the findings of the panel WILL make it more difficult for women to get mammograms who want them in the future.

I can't help but wonder if when these women are diagnosed at stage 3 or 4 the next thing will be to say "why bother treating you, your cancer is too advanced" sound ridiculous? I would have thought discouraging mammograms and self examination was ridiculous too!

So it seems pretty clear as time goes on this issue is less and less about finding better diagnostic tools and more about finding ways to cut costs with women's health.

Funny, I don't see anyone wanting to stop covering Viagra or Cialis.

[havocmom]

1. You expressed my concerned eloquently

Thank you.

Women get more medical care, as a rule. Seems we are being re-evaluated by the accountants. Too bad care is not chosen by doctors and patients anymore.

It's not just the cost of chemo and radiation, there is the savings from reconstructive surgeries that can be saved, along with years of follow up care. Cancer survivors and their doctors seem to get pretty serious about ongoing health care. That must cost the insurers some profit. Bet the corporate officers have other ways they want to spend all that health care money.

Yeah, I feel like women are being considered as financial liabilities rather than human beings. But then, I have felt that way for almost 20 years; ever since I noticed that if you don't have lots of coin, or are strong enough to be exploited, you have no value in America.

[Bitwit1234]

2. And why why why after all these years

do they still use the same torturous method of taking mammograms. This is barbaric..they could find an easier way that is less and I mean less painful. I bet when they examine a MAN'S prostrate they don't use the same equipment.

[Robyn66]

3. I don't know how they check a man's prostate :)

But imagine if it was with a mammogram machine!

I agree that we need new methods. I am amazed that we still are using mammograms after all this time. A mammogram saved my life so I am content to go through the pain and "anxiety" of a mammogram if necessary.

[Celebration]

5. on the other hand

this is an interesting read

http://www.washingtonpost.com/wp-dyn/content/article/2009/11/20/AR2009112003718.html

"Often I hear a woman say something like, "My life was saved by because of a mammogram I got when I was 39 and breast cancer was detected." But we don't know that her life was saved by that mammogram. She might have found the lump herself the next day, in the shower, or the cancer might have been an "in situ" cancer that would not have become invasive and might never have harmed her. It seems to her as if the mammogram "saved her life," but we cannot know that, and if one looks across many women in her age group, we don't see that on average this would be true.

In 1986, I found a breast lump that turned out to be breast cancer. I was 34. Because of my age, I had never had a mammogram. I sometimes wonder whether it would make just as compelling a sound bite if I said, "I found my own breast cancer without breast self-exam or mammography, and that's why I am still alive." While it is true that across populations taking early action against a breast cancer diagnosis saves lives, it is not always true that the method of detection can be credited. That is what the review is saying: Except in a few cases, we cannot credit mammography with saving women's lives in the 40-49 age group."

[Robyn66]

16. I know for a FACT a mammogram saved my life

I was diagnosed at the age of 42 with Infiltrating Ductile Carcinoma. I was told my my oncologist at Dana Farber that this is the most COMMON type of Breast Cancer. Its bad enough I blew off having a mammogram when I was 40 because we might have caught the cancer before it got into one of my lymph nodes.

If I had not gone for the mammogram, and waited until the cancer was either detectable by touch or when I was 50 the cancer would have been significantly advanced if not terminal by the time I was diagnosed. I was told the cancer was not caught early but in time.

I have been told my experience is irrelevant. But I fear for those women who are going to be the collateral damage of this report.

[unc70]

12. I know how they check the prostate, you should know, too.

The prostate checking is two stage. The first is the PSA blood test. If the PSA is out of line (high or increasing), then they do a biopsy. The recent guidance for PSA checking has been modified in much the same ways as the guidance for breast cancer; it isn't cost-effective to be checking so much. They are now pushing "watchful waiting".

The PSA blood test is a lousy diagnostic, but it is the only non-invasive one available. It produces high levels of false positives and false negatives -- it indicates a problem when none can be found, but also misses many cancers until it is too late for effective treatment.

Unlike the PSA test, a prostate biopsy is quite invasive. The doctor uses an ultrasound probe to image the prostate, then uses the attached instruments to take core samples of the prostate by cutting through the bowel wall for each sample, usually gathering 12 samples each about one inch long. As they say, "You may feel some pressure, and it might sting a bit."

YMMV! I was not given any pain killer or sedation for my first biopsy twelve years ago. The pain was intense. Remember that the prostate is among a man's most sensitive organs. Lots of nerves. I changed to another doctor after that. After the procedure, there is blood in urine and ejaculate for 4-8 weeks. Even possible to cause ED problems, depending upon how the nerve bundles are positioned around the outside membrane.

Last year a biopsy finally found cancer in my prostate and I had surgery last winter. We caught it just barely in time (we think and hope), it was starting to grow outside the prostate.

[CTyankee]

15. I used to think that doctors were mindful of patients' suffering. I know differently now.

I'll never again submit to an endometrial biopsy (altho it was not as invasive as what you described!) without some form of sedation. I will never again undergo a barium enema study (take me straight to a colonoscopy; at least I'll get drugs). And my daughter decreed that after her first "natural" birth where she had asked for pain medication but was told "too late", she would have a medicated birth for her two subsequent pregnancies, no ifs ands or buts.

I hope you are okay. After what you have been through, it's a wonder you didn't strangle your docs...

[GoCubsGo]

8. "Torturous"???

I guess I must have a high threshold for pain or something, because they didn't hurt at all when I got them. And, I've had several, including the second-round, check-every-angle exams due to suspicious areas--twice. I consider female circumcision to be "barbaric." Mammograms--more like an uncomfortable nuisance.

[LWolf]

10. I regularly show benign cysts.

The problem? Their in my armpit. They don't show clearly on a mammogram, no matter how much tissue they try to force between the crushers.

So they call me back to redo the mammogram.

After I've been crushed unsuccessfully twice, they'll allow an ultrasound, which shows cysts.

When I ask if we can do the ultrasound first, and just skip the crushers, it's a negative. Not covered my my "good" insurance unless the mammogram doesn't work.

[NotGivingUp]

4. Mammograms CAUSE cancer. Turn off your tv set and do some research. n/t

[chimpymustgo]

14. Would you share some of your knowledge and research?

[rebel with a cause]

19. I have not heard that they cause cancer

but I have heard that they can make developed cancerous tumors worse. The premise I read was that by squeezing the breast, it put pressure on the cancerous tumor that could cause it to spread or even burst(?). It has been a while since I read this and I do not know if it has any credibility.

As for the pain thing, I believe a sonogram is more efficient in determining if you have tumors. I know this because when monograms find unexplained masses in my breast, they then send me for the sonogram. With the sonogram they can determine if it is a tumor or some other type of tissue mass. This method would probably be more expensive and time consuming than a monogram, but it is also less painful. On the other hand, monograms are not near as painful as they use to be.

[PHIMG]

6. Making this a battle of the sexes is ridiculous.

Why not focus on all the women who go thru hell thinking they have breast cancer, getting expensive and painful biopsies, losing work, and for nothing (as the research says?)

You know who really hates this study? Manufacturers of mamography machines and the clinics that operate them.

If a woman has high risk factors for breast cancer the doctor will order the tests.

We have to allow for the fact that TOO MUCH SCREENING can be a bad thing. That's what the doctors that did this study found with thier science. To reject it as some plot against women or tie it the viagra issue is stupid in the extreme.

Let's leave the war against science to the republicans, m'kay?

[Robyn66]

18. I would have given anyting to have had a negative biopsy

How much happier would you be to find out when you are 50 that you have stage 4 breast cancer that could have been caught in your early 40's. The so called scientists don't want to hear this. But this is the most important part of the argument. Its about women's lives.

And Dr, Nancy has no problem with admitting this is rationing but rationing can be ok.

Maybe its so personal to me because I am one of the 1 in 1900 and one of the people who's death is ok with people like you.

[PHIMG]

20. You ignore the science because of your experience

Medicine is a science. The science in this study was strong. You reject it on what? Do we bankrupt the country and expose patients to negative effects to screen the entire nation for every single thing despite that we can screen for?

In Medicine science and reason trump the emotionalism of personal experiences.

Your argument could be used to argue for screening every six months. Where does it end?

[Barack_America]

7. Actually, it's completely different.

The guidelines speak of the value of mammograms as a diagnostic tool for breast cancer. They say nothing about the value of the lives of women with breast cancer.

The bottom line is that mammograms are a pretty shitty tool. The problem with the guidelines from my point of view is they suggest nothing to replace mammograms as the current gold standard when it comes to breast cancer screening. The fact that we are currently without a sufficiently reliable tool to detect early breast cancer is the problem. The new guidelines merely highlighted this fact, they did not create it.

[Robyn66]

17. That is true but the other fact is

that there are women who will go from using a flawed tool to NO tool. I agree that a mammogram is not the greatest but as I have said the guidelines are not reccomending finding a new method of diagnosis they are reccomending to stop trying to diagnose.

I don't know how you can separate denying the value of looking for the disease from devaluing the lives of these women. A lie by omission is still a lie.

[Ratty]

9. Women in their 30s get breast cancer too

Why isn't screening recommended for women in their 30s?

[Barack_America]

11. The same reason double mastectomies for women in their 20's isn't indicated.

Though that would prevent breast cancer.

The risks outweigh the benefits.

[Delphinus]

13. I agree with what you write.

I heard stories, years ago, about women not having relations with their husbands until things changed. That needs to happen again. No more babies for the war machine; no more sex until we're treated as though we matter.