This needs to be repeated. And bolded. This is the thing about screening tests in general that some people just don’t get. How they can cause more harm than good, unless the population to be screened is very, very carefully selected.
Unfortunately, we’ve made little progress in convincing the public of this. Question the way we currently do breast or prostate screening, and a virtual riot breaks out.
I’m having a hard time not taking this personally.
My mother died of breast cancer at the age of 48 when I was in high school. She had originally been diagnosed at about 40 and successfully treated only to have the cancer come back with a vengeance several years later. There was no family history (at the time) and no major risk factors. Had she waited until she was 50 to start getting mammograms, she would wouldn’t have made it to the first one (and that’s with years of state of the art treatment; without it, well, I shudder to think.)
A lot of talk is thrown around about how harmful it is to treat patients who don’t really have cancer and how terrible the anxiety is for people receiving false positives. Could someone explain to me how this makes testing bad? It seems to me that it points to a need for more/better testing before setting a diagnosis in stone rather than no testing at all. If doctors see a test and jump the metaphorical gun, that is the fault of those doctors, not the tests themselves. How does psychological stress over a false alarm outweigh the risk of letting cancer go undiagnosed? This whole thing positively boggles my mind.
The argument that it saves money for the insurance companies if fewer tests are performed might be the part that pisses me off the most. It would save them a whole lot of money if no tests were performed, ever. It would save insurance companies even more money if no one ever got any form of medical treatment. That’s not the point. Doing their job might hurt the bottom line, but that’s too bad; it’s their job! If a company doesn’t do its job, there’s no reason for it to exist.
Sorry if I’ve ranted a bit. I’ve been building up more and more steam with each newspaper article I’ve read on this heap of crap and I had to vent some of it. As I said, I’m having a very hard time not taking it personally.
I’m sorry about your mom - I lost mine at 44 to cancer (lung, not breast) and it was awful and painful and tragic.
But separating it from the emotional - the insurance company does not “save money”, the regular people who make up the insurance pool and pay the premiums save money.
We’ve been reading about the tremendous lines at ERs and doctor’s offices lately due to the flu. People were freaking out and jamming waiting rooms - for the flu. Unless you are in a high-risk group, or have a rare reaction, like a 105 degree fever, there was no reason for anyone to go the doctor. However, since most people have no clue as to how expensive seeing the doctor is, they just decided they needed to see the doctor.
One of the big reasons why medical care is so expensive is because of that disconnect. People think they should be entitled to whatever medical care they choose, no matter if it is wasteful. The pre-50 mammogram is an example of this. Again, no one is saying that they can’t have it done, just that the cost of doing so shouldn’t be borne by everyone else, since it is generally wasteful. No one feels that way about their mom, but in order to be efficient, we have to set these limits.
I’m very sorry to hear about your loss.
The thing here is, this isn’t an issue that can be separated from the emotional. This isn’t just a discussion about health care costs and availability. It is just as much about peoples lives.
Whether or not a mammogram is available isn’t the problem. The problem is that by declaring them to be “generally wasteful”, you are disincentivizing women to get them, available or not. That means that more cases will go undiagnosed and more people will die. Letting people die who could easily have been diagnosed and treated, even in the name of reducing health care costs, leaves a bad taste in my mouth.
QtM
You’re quite correct about the cost of false positives, but from the potential patient perspective, they’re not seeing the false positives - they’re seeing themselves as maybe being that one person who catches that treatable cancer early.
And arguably, the great improvements in reconstructive surgeries, in less invasive and less destructive therapies somewhat lessens the cost of treatment.
But it’s hard to get the Patient out of the Patient Perspective - because they’re patients.
There is a similar argument raging in Prostate cancer, with Otis Brawley giving and taking flak. From the patient perspective, walking around with what might be cancer, watchfully waiting to see if that atypia slides or flies into malignancy isn’t worth the stress.
I’m having a bit of a hard time with this, too. The value of someone’s life seems to be being measured somewhat unfairly against the psychological trauma of false positives and unnecessary treatment.
Speaking personally, I would gladly go through that, including losing a breast, if it meant someone else got to go on living. Now, how much money and how many lost boobs is a person’s life worth, I don’t know. But I don’t think I’m alone in thinking it isn’t anywhere near a 1:1 ratio.
According to irishgirl’s data, it would seem to be up to 20 breasts, right? (Two boobs per woman, though I imagine the chances you’d wind up losing *both unnecessarily are pretty slim). So one person’s life is worth up to 20 boobs and bald heads, plus 220 stressful/physically bad experiences. I can live with that.
*200 false positives + 10 rounds of chemotherapy and 10 of radiation
I listened to a program about this issue, related to prostate screening, on the CBC, as well as a segment on This American Life (always a bastion of scientific journalism, I know!) and while I’m not a medical person at all, I got that it was more complicated than I would have assumed before. So I have nothing to add, but I just wanted to say that I have heard more about this issue in the last few months than ever before and I somewhat understood, so the message must be getting out.
I am not, however, the right sex to be at risk of prostate cancer and a few decades away from real risk of breast cancer, so I can also afford to look at it that way. I’ll probably be crying for my mammogram at 40, though! (Though we don’t get them till 50 under Ontario insurance, anyway.)
The thing is, it’s not just bald heads that will one day grow hair again and cutting off some boobs and that’s the end of it.
Once you get past straight x-rays into imaging that requires dyes and contrast there is the risk of adverse reactions up to an including death. I used to work with a radiologist who left clinical practice after one too many patients she was injecting with contrast up and died suddenly due to a bad reaction.
Biopsies are surgical procedures that, again, can result in adverse reactions, including death.
Removal of breasts in some cases lead to chronic edema and significant loss of the use of an arm. Or both arms.
Radiation treatments can cause heart or other organ damage leading to early death.
Chemo is toxic - a certain number of cancer patients every year die from the chemo itself and not their cancer.
So… you need to balance the lives saved from breast cancer with the lives lost to complications of over treatment.
Clearly, we need to keep improving testing to make it ever more safer and more specific so we don’t poke around harmless lumps and do get rid of dangerous ones. Meanwhile, we have to balance risks and benefits.
I will go with the crowd that says the advice is stupid. Women should get checked.
Stupid, stupid, stupid advice!
My good friend in Chicago, Candace Ferger, was a funny, talented actress who also had a mother and grandmother die of breast cancer at an early age.
Candy was terrified of breast cancer, but she never once got tested.
She died at the age of 31 - of breast cancer - because despite her family history, she never once had a mammogram until it was too late.
Whenever someone tells me “oh, but x% isn’t that much!” I offer to have his salary reduced by that %. For some reason, x goes from being unimportant to being their children’s blood.
Spain screens yearly starting at 45 if there’s no medical history at all. I got sent in at 40 due to 3 breast cancers between both blood aunts (one on each side), father dead during his 3rd bout with pleural cancer (the official cause of death was an aneurysm, which we’ve nicknamed The Favor), father’s family tree showing “COD: cancer” in about 3/4 of cases since 1800.
No, we have to stop the idiots from their little lemminglike panic attacks. They need to have it HAMMERED into their little pea brains that yes, there is a flu, and no do not crowd the doctors offices UNLESS <insert specific symptoms> occur. I guinea pig the flu vaccines every year and obviously this year I was in the placebo group as I got the flu. My roomie didnt [damn her eyes! :D] but I did not run to the doc or er as I knew enough not to.
And that’s an example of a special type of high-risk patient who is currently and will continue to be encouraged to get mammograms and other breast evaluations at an early age and regularly.
So how does her experience relate to the recommendation that low-risk women are better served to have fewer mammograms at a later age? What makes that advice stupid?
Did you read the case which demonstrates why it may do as much harm as it does good?
I’m sorry about your friend, and the same goes to everyone else who has lost a friend or family member to breast cancer. But it’s worth pointing out that these guidelines would not have applied to her. A woman whose mother and grandmother died of breast cancer when they were young is high risk. Quoting from the panel, “This recommendation statement applies to women 40 years or older who are not at increased risk for breast cancer by virtue of a known underlying genetic mutation or a history of chest radiation.”
[Edit: Agh, Qadgop the Mercotan got me.]
I wanted to return to this because I think I saw CNN addressing it this morning. There are 16 people on the panel, and eight of them are women. So I’m having trouble seeing the sexism inherent in the system here.
But if even one woman dies of the complications, then the whole thing is a wash. And the data suggests that we’re spending billions on screening as it is done now, with subsequent interventions, only to have no net gain.
The primary principle of medicine is Primum non nocere, or “First, do no harm”. It’s not certain we’re even meeting this standard with current screening.
Don’t care whether the motivation is scientific or political - it’s great news for me. Now I can tell people to lay off me getting that noxious test for another 3 years, when I’ll find another reason to reject it.
They would have applied to my sister however, who, prior to her diagnosis, had one maternal aunt with breast cancer at 60. However, it already didn’t apply to her - she was 37 when she felt a lump.
My girlfriend who passed on Tuesday was old enough to have gotten screened. I have no idea if she did or not or if they missed it, or if it was fast acting or why it wasn’t caught earlier. It was pretty far along when caught however.
It would have applied to my cousin - 43 at diagnosis, who was discovered via a mammogram.
It would have applied to another friend - 41 at diagnosis - caught during a routing mammogram.
But never applied to a friend’s sister - 38 a diagnosis.
(If you are counting, for me that’s one sister, one aunt and one cousin - the daughter of the aunt. No known gene mutation however - its also two friends and the youngish sister of a third…all in five years. I may be a statistical anomaly. My real life circle isn’t that large).
Cogently put, broomie.
If we’re going to invest billions and billions of dollars in massive screening, we really do need to know that we’re doing more good than harm.
Qadgop, please help me understand. I was not high risk. I had no family members who had breast cancer. I don’t smoke. My lump was found with a routine mammo at age 40.
Since there were no red flags, are you saying I should have waited 10 years for a mammo or until the lump got so big as to be noticeable? (note the panel is also saying self-exams don’t work.)