Earth to public health pundits: you can’t correct one extreme by swinging to the opposite extreme.
Here’s a super-important issue that this whole mammography debate is only glancing off: no one is offering anything to pre-menopausal women. Yes, I understand that the epidemiology shows little or no benefit. Yes, I understand that (1) the benefits of mammography were grossly oversold, and (2) the risks were grossly understated. Those were preventable mistakes, by the way (don’t get me started on the failure of our medical system to provide breast health specialists).
But, epidemiology aside, if you spend a month in the infusion center at any cancer clinic, you will meet women in their 30’s and 40’s with terminal breast cancer precisely because their doctors pooh-poohed the mammo (”you’re too young for breast cancer”). No amount of epidemiology or number crunching can get around the fact that, for some women, mammograms DO save lives, or at least breasts.
What the debate is mostly ignoring so far is this: that there’s a difference between public health recommendations and personal choice, but that in our current regulatory and insurance atmosphere, decisions in the public realm can obliterate choices in the second. Epidemiology is an important input into public health decision making, but is not the final answer in personal decision making, especially when our tools for identifying “high risk” women suck even worse than mammography. Are you Ashkenazi Jewish? No? Then no mammo for you. That’s what our individual risk assessment tools boil down to – BRCA. The cause of maybe 10% of breast cancers.
My two cents (okay, maybe this is four cents):
(1) There are still excellent reasons to get a mammo under the age of 49 (lost in the population data is the fact that some lives and breasts ARE saved), and
(2) doctors have been worse than abysmal at understanding and communicating the risks, and
(3) women under 50 should be allowed to choose and should be offered the information needed to choose intelligently, but
(4) the task force recommendations will likely eliminate this choice by leading insurers to drop pre-meno mammo coverage like a nuclear potato.
All of which makes me sad, and worried, that if the choice to obtain a mammogram is taken away from pre-menopausal women, that there will be more women like the ones I met at the cancer clinic.
Medicine has done an abysmally poor job at explaining the risks and benefits of mammograms to pre-meno women. But the answer to that failure isn’t to abandon this population altogether. That’s just swinging from one simplistic extreme to another.
What’s missing from the mammo debate
Earth to public health pundits: you can’t correct one extreme by swinging to the opposite extreme.
Here’s a super-important issue that this whole mammography debate is only glancing off: no one is offering anything to pre-menopausal women. Yes, I understand that the epidemiology shows little or no benefit. Yes, I understand that (1) the benefits of mammography were grossly oversold, and (2) the risks were grossly understated. Those were preventable mistakes, by the way (don’t get me started on the failure of our medical system to provide breast health specialists).
But, epidemiology aside, if you spend a month in the infusion center at any cancer clinic, you will meet women in their 30’s and 40’s with terminal breast cancer precisely because their doctors pooh-poohed the mammo (”you’re too young for breast cancer”). No amount of epidemiology or number crunching can get around the fact that, for some women, mammograms DO save lives, or at least breasts.
What the debate is mostly ignoring so far is this: that there’s a difference between public health recommendations and personal choice, but that in our current regulatory and insurance atmosphere, decisions in the public realm can obliterate choices in the second. Epidemiology is an important input into public health decision making, but is not the final answer in personal decision making, especially when our tools for identifying “high risk” women suck even worse than mammography. Are you Ashkenazi Jewish? No? Then no mammo for you. That’s what our individual risk assessment tools boil down to – BRCA. The cause of maybe 10% of breast cancers.
My two cents (okay, maybe this is four cents):
(1) There are still excellent reasons to get a mammo under the age of 49 (lost in the population data is the fact that some lives and breasts ARE saved), and
(2) doctors have been worse than abysmal at understanding and communicating the risks, and
(3) women under 50 should be allowed to choose and should be offered the information needed to choose intelligently, but
(4) the task force recommendations will likely eliminate this choice by leading insurers to drop pre-meno mammo coverage like a nuclear potato.
All of which makes me sad, and worried, that if the choice to obtain a mammogram is taken away from pre-menopausal women, that there will be more women like the ones I met at the cancer clinic.
Medicine has done an abysmally poor job at explaining the risks and benefits of mammograms to pre-meno women. But the answer to that failure isn’t to abandon this population altogether. That’s just swinging from one simplistic extreme to another.