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Who says I can’t have a mammogram?

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11/24/2009

Who says I can’t have a mammogram? photo

So here’s a question for you. Cancer: good or bad?

You’re a little perplexed that I’ve framed the debate this way, aren’t you? The answer couldn’t be more obvious if it was written in big lights up and down the skyline. Cancer is horrible, and you’d be hard-pressed to find someone who hasn’t been affected by it somehow. If there’s any way to prevent suffering like that, it should be pursued to the utmost, right? It’s why women endure mammograms and Pap smears and men go through prostate exams: to establish a baseline of normal health and to try and catch cancer in its earliest, most treatable stages.

Up until last week, if a woman had no increased risk of breast cancer due to family history or a genetic predisposition, such as a BRCA mutation, the commonly accepted timetable was to start getting yearly mammograms when she turned 40. Last week the U.S. Preventive Services Task Force ignited a firestorm of controversy when it issued new recommendations. What they said was that low-risk women should start mammograms at age 50, and should only go in every two years. They also wrote that there is insufficient evidence that breast self-exams catch cancer at a higher rate. What many people heard was: Women’s health isn’t important, and women are overreacting.

It feels like an odd claim, right? Why on earth would anyone think scaling back preventive screenings is a good idea? Is this the medical equivalent of “Why do you hate freedom?”

The USPSTF sees this issue as a conflict between evidence and anecdotes. Even as thousands of women are coming forward and talking about their own experience, that they would be dead if a mammogram hadn’t checked that lump at 39, the task force believes there are fundamental misconceptions in the popular notions of cancer, which are hurting more women than helping. Breast tissue changes as women age, and different imaging techniques produce very different answers from case to case. The task force sees unnecessary biopsies, unnecessary chemotherapies, unnecessary surgeries and unnecessary anxieties on a widespread scale. We, the American public, are just not used to being told that you can, in fact, be too careful, particularly with regards to cancer.

I’m not shilling for their position. The truth is I’m not sure what to think. I’m 25, with a liberal arts degree, and my particular family history doesn’t suggest that I’m at any higher risk than normal. That means I’m due for my first mammogram sometime after 2024, and a lot can change in fifteen years. But here’s the thing: that question from the beginning of this post? The answer hasn’t changed in the last five minutes, and it hasn’t changed since the USPSTF offered a new suggestion about how we think about preventive screening. Cancer is still horrible, and even though it’s not October and the world isn’t smothered in pink ribbons, we’re talking about it. We’re listening to our mothers and aunts and sisters, and we’re asking our doctors about our options. If we’re able to understand all sides of the conversation, not just the ones we agree with, that’s how we move forward.

If you’d like to learn more about the issue, including the text of the recommended guidelines, the Chicago Center for Jewish Genetic Disorders has a link roundup at its blog.

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