Speaking of bras…

…let’s talk about breasts.

Keep A Breast

This week, the US Preventive Services Task Force (USPTF) released a new set of recommendations for breast cancer screening that turns on it’s head what women have come to expect as far as screening for breast cancer, the second leading cause of death in American women.

Recommending that women not receive mammograms until the age of 50 and then once every other year after that, the USPSTF has concluded that “the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination beyond screening mammography in women 40 years of age or older.”

That part about “current evidence is insufficient to assess the additional benefits and harms” raised my eyebrows. Insufficient evidence to make a call either way? So that means this influential panel upends the current protocol—mammograms every one to two years beginning at age 40— instead of sticking with it?

*Shakes head.*

Call me crazy but the new guideline instantly made me think this is has something to do with money. But what really got my hackles up was this next part about how the USPSTF “recommends against clinicians teaching women how to perform breast self-examination.”

Whaaaaaaaaaaaaat?!? As if the first part of this announcement wasn’t disturbing enough on its own, this second bit feels utterly irresponsible and lazy and callous and pitiable and oy vey, I need a drink. Or a bong hit. Or a shopping spree at Anthropologie with Michael Bloomberg’s credit card.

Now, perhaps there’s a reasonable reason for postponing mammograms. Probably not, given all that copious “insufficient evidence,” but I’m willing to suspend disbelief for a moment and offer a one-time-only benefit of a doubt on this one. I’m feeling generous today. But how, how, HOW can it be bad for a woman to learn what her normal breast tissue feels like? Someone? Anyone? Bueller? Because if you know normal breast tissue when you feel it, you will know abnormal breast tissue when you feel it. You feel me? Which makes me think immediately of my friend Amanda.

IMG_5063.jpg

Isn’t she gorgeous? Vivacious? Young? Indeed. Gorgeous, vivacious, young Amanda found a lump in her breast with her very own fingers  and was diagnosed with stage-3b breast cancer when she was just 27 years old.

I LOVELOVELOVE This One!

Amanda is a breast cancer survivor. You can read Amanda’s story here.

I’m curious to know: How do you women (and my male readers, too) feel about this dramatic shift in women’s health care? Do you feel like maybe we’re getting the shaft? Just a little?

12 Responses to Speaking of bras…

  • Celeste says:

    In the midst of all of this, is that we are “over-diagnosing” breast cancers. That some of those found will involute and never prove to be a clinical problem.

    Great. The body is a complex and wondrous thing and is, when working appropriately designed to stop cancers before they become a problem. But, do we mere mortals have any means to determine which cancers will be clinically unimportant and which WILL go on to become a huge problem, potentially a terminal problem. (Silence). Exactly.

    In general, breast cancer in younger women tends to be more aggressive. It is also harder to diagnose via mammogram because of the increased density of the younger breast. Still….just because it is harder doesn’t mean that one shouldn’t look.

    Congrats and long health to Amanda!

  • Les says:

    I was shocked when I heard this. I really don’t care what the percentage is, the fact that mammograms and self exams help women find cancers at all is reason enough in my book to continue having them done on an annual basis. I have seen that the American Cancer Society is recommending keeping the current standards of an annual mammogram and doing regular self-exams. Having had two “suspicious” lumps biopsied over the years I can tell you it’s no trot in the park, but it’s less anxiety producing than not being allowed to be tested and not knowing, but worrying anway. 50 is too old to start mammograms. Many, many women will die and some of those who are diagnosed will cost much, much more to treat because their illness will not have been caught in a timely fashion. These recommendations are a slap in women’s faces.

  • Jenn says:

    incomprehensible that we should not know our own bodies inside and out… WITH the support of the medical community (it’s supposed to be HEALTH care, not SICK care)…

    BTW my sister was diagnosed– at age 40 with Stage I breast cancer– she found a lump, had it biopsied, removed, radiation, chemo, the works. Then three years later diagnosed with Stage IV (they hadn’t gotten it all apparently). And now, 4 years later she’s gone back to work at the airlines because she can’t afford to not work, AND have health insurance. She is doing great, but seriously she doesn’t have the same kind of energy she had before… but I digress.

  • ~annie says:

    No way I’m NOT going to self examine. My gyn barely looks at my breasts, let alone doing a thorough CBE. I don’t see how early detection could possibly be undesirable or detrimental.

  • Robert K says:

    FWIW, here’s the original statement from the USPSTF. And here are members of the USPSTF.

    In reading the report, I’m struck by a couple of things …

    I can buy the argument that there are certain risks to over-diagnoses. Specifically, that false-positives lead to unnecessary biopsies. I’m assuming there’s some harm that may result from those biopsies, but ‘not sure what exactly. I don’t see unnecessary anxiety as a real (or at least quantifiable) harm.

    The recommendation against Breast Self Exams (BSE) surprised me as well. The rational for that is that research shows that BSEs are only 12-41% reliable in detecting a positive result (cancer). Clinical Breast Exams (CBE) are significantly better, at 40-69%. In that light, the recommendation kind of makes sense – women may incorrectly rely on their self-exams and, thus, not go in for a more reliable test. Or, at least, that’s the only explanation I can come up with for this recommendation.

    The report says, “biennial screening produced 70% to 99% of the benefit of annual screening.” So… if it’s 99%, I’m totally on board with the recommendation to reduce testing to every 24 months. But if it’s 70%, sorry, get tested every 12 months. I.e. this seems a poor basis for making the biennial screening recommendation.

    Overall, the report is certainly an interesting (if slightly technical) read. I’m certainly much less critical of the recommendations having read it than I was before. However I do think they could have gone a different direction, such as recommending better BSE/CSE education and training to help improve the reliability of these tests, rather than doing away with them altogether.

  • The part about self exams is crap. How many times have we read a woman’s story and she mentions finding something abnormal while in the shower?

    As for mammograms, I’m trying to educate myself on the idea that exposure to radiation increases the risks. I’ve had a mammogram and an ultrasound and both eased my mind tremendously.

    I don’t think you’re grasping at straws to wonder if money is at the center of this somehow. I’m taking my video camer with me on the 3 day and plan to ask others what their feelings are too.

  • My curiosity about these new recommendations borders on suspicious. About money, too. Wondering who funded this research.

    The part about no self-exams? WTF? What harm does this do? Are there women jamming doctor’s offices with false lump detection syndrome?

    And how would a woman discover a lump, otherwise? Wait for her man to feel it? Was this a panel of men making this new recommendation? I really do not get this part, at all.

  • mike says:

    finally, a policy we agree against! :)

    two of my mentors quoted here, like everyone else I know in the biz, in total shock…. drs. poller and keenan quoted within are personal friends and mentors:

    http://www.postgazette.com/pg/09322/1014306-455.stm

    although, i do blame your a’changin’ prezident…

    http://online.wsj.com/article/SB10001424052748704204304574543721253688720.html

  • MidLifeMama says:

    I just posted about this on my own blog. It is nauseatingly negligent.

  • bonzize says:

    One of my six dear sisters was diagnosed with a Her2Nu tumor when she was 46. She had mentioned the lump to a very experienced surgeon who told her it was nothing and that she shouldn’t panic everytime she felt something in her breast (she had two previous biopsies that were benign). But when it showed up during a screen mammogram, and removed surgically, it was cancer. Imagine if she had not known how to find lumps, or that no one had sent her for a screening mammogram before she was fifty. Imagine if she had listened to the very experienced surgeon. She would be dead. Thank DOG for mammograms and BSE.

    xoxo, yfgm

  • kerryanne says:

    I heard this on a a podcast this morning and almost threw up. On the one hand, I can sort of see the rationale behind not doing mammograms until a woman is a bit older, and not in a high risk category (that’s how it is here in Holland and seems to be okay- they also routinely do the test – forget what it’s called- on women who have a mother/aunt/grandmother who had the disease to see if they carry the gene).

    BUT I have to shake my head NO at the suggestion self exams are not worth encouraging! Good God! I, like you, have a friend who was diagnosed at the age of 32 with stage 3 after finding a lump herself. She is alive and well, & thank God she had a habit of doing self exams.
    Here in Holland, I have yet to meet a Dutch woman who knows how to do a self exam because it is not taught. Regular pap smears are not done until women are in their 30′s (that’s a whole other effed up thing), so what I have noticed is that there seems to be a lot of *young* women here diagnosed with breast cancer at *later* stages. They only find out they have it because other symptoms arise or they or their partner happen to accidentally notice a lump- not because they were actively checking.

    Well this was a long comment…

  • Megan says:

    Sometimes when I’m asked at the checkout stand whether I want to donate a dollar to prostate cancer research, I consider throwing men a bone. I think: sure, breast cancer runs in my family, but there’s so much press and support for breast cancer research, maybe the guys could use a little help. But if they’re telling us to stop self exams and forgo mammograms until 50, sign me up for the 3-day today! I had no idea things were so backwards.

    To me, this sounds like an effort to keep “paranoid” women out of the doctor’s office when they feel something that’s a bit off. This isn’t the same as cutting costs with electronic records–this is my mom’s life, my life, my friends’ lives. Self exams and mammograms are what saved my mom’s life after doctor’s told her there was nothing wrong.

Leave a Reply

Your email address will not be published. Required fields are marked *

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>