Breast Cancer Screening: Why I Support the New Guidelines
| December 14, 2009
Media coverage of the new guidelines regarding mammography screening has emphasized controversy and focused on fears about health rationing. However, many women’s health advocates have, for years, warned that the tests are oversold. Here, the author explains and asks us to take a rational look at the evidence.
As a feminist health activist and public health nurse I support the right to full disclosure of research and all relevant information on health so that each person has the freedom to make informed decisions over their own bodies. Decisions based on solid research—not sexist policies, corporate greed or political sell-out.
The U. S. Preventive Services Task Force (USPSTF) conducted a systematic review of mammography screening and concluded that the evidence for such tests of women before the age of 50 years is equivocal and the evidence for breast self-examination is inconclusive. First a word about breast self examination—the studies are clear that women find their own cancers but that it is usually through the many ways we check out our breasts randomly while in the shower or in front of the mirror while getting dressed. What the guidelines say is that to have doctors teach formal BSE is not useful.
The task force reported their last set of recommendations in 2002 and base these new guidelines on an extensive review of the data. It is just coincidental that they came out during the health care reform debate and right on the heels of our outrage of the passage of the Stupak-Pitt amendment dismissing women’s health needs—yet again—for political favor and votes. It’s no wonder these new guidelines have been met with a highly charged and emotional reaction from women.
The truth is women have been oversold the benefits of mammography in this pink-ribbon-crazed fear-based breast cancer culture we live in. Devra Davis, PhD. MPH (The Secret History of the War on Cancer) states, “Mammography is one of the most oversold and understudied technologies in the medical history.” Who can women trust about their health? Politicians, greedy corporations, researchers who don’t disclose their financial ties to companies that pay them to ghost write articles, hide negative outcome data and only report positive findings to help companies sell their drugs, medical devices, and surgical procedures? The flawed findings from such studies then wind up in the hands of politicians from well-paid lobbyists that drive health policy.
As a feminist health activist who has followed the debates over mammography since the technology was introduced in the 1970s, I'm convinced that the current controversy has resulted from the premature promotion of mammography to younger women. Both the American Cancer Society and the National Cancer Institute had recommended mammography for women ages 35 and older—before any research supported the advice. There was considerable controversy then, and a widespread belief that the recommendation to extend screening to women under 50 depended less on evidence than on politics.
What the new guidelines state is that baseline mammography should start at 50, not at 40. They don’t say never do it from 40 to 50 but just don’t automatically do it. Dr. Susan Love stated it clearly, “Mammography is not a good tool for finding breast cancer in younger women and we need to put our efforts to finding something better. Young women’s breasts are more sensitive to low dose radiation and starting yearly mammograms at 40 will cause as many breast cancers as it will find. With age the breast sensitivity to radiation becomes less and mammograms become more accurate and so it becomes worth it.”
The real issue is not whether mammography can find cancers but whether it can find them at a point that will make a difference in the outcome. Over-diagnosis is hard to believe when we hear the individual stories of women younger then 50 with breast cancer, but it is a very under appreciated byproduct of mammography screening. Individual stories don’t constitute science. As a women’s health advocate I ask that you read these findings objectively and hear the evidence for these updated guidelines. Mammography screening does save lives, but the truth is at a far more modest rate than what women have been led to believe.