breast cancer

The Mammography Debate

Last Fall, I gave a celebratory cheer when the new mammogram guidelines hit the news. As a health reporter, I’d long been privy to the fact that there is no medical evidence supporting annual mammograms for all women over 40. And it drove me nuts that no one seemed to care. All women over 40 kept lining up to get their boobs squished every year, like clockwork.

“Eureka!” I thought when I saw the headline. “Someone finally came to their senses.”

That someone was the United States Preventive Services Task Force, a 16-member panel of experts. Our tax dollars pay them to peer into such pressing issues as—does breast cancer screening really work?

Peer they did, and what they found was a dearth of scientific evidence supporting the current guidelines of annual mammograms for all women over the age of 40. As it turns out, breast cancer screening for all is not only a waste of time and money but the annual event feeds a cauldron of fear and erupts in false alarms for hundreds of thousands of women.

Here’s one way to look at the pros and cons of mammograms for all women over 40, via the NYT’s “Gauging the Odds (and the Costs) in Health Screening:”

The numbers show that about 2,000 women need to be screened regularly for a decade to avert one breast cancer death.

But…during that decade up to 20 women screened will be “overdiagnosed” and get radiation, chemotherapy or a mastectomy unnecessarily.

About 5 to 15 women will get treatment at a younger age than they would have otherwise, without improving their health outcomes.

Most were going to do fine without screening by beginning treatment of their cancer when the symptoms became evident,

…and a few were destined to die whether or not they had early screening because their cancer was fast-growing.

So, unless a woman has unusual risk factors for breast cancer, the Task Force recommends screening start at age 50 (not 40) and happen every two years (rather than every year).

Seems simple enough.

So, a few weeks later, when Mary and I were face-to-face with our primary care physician, I asked, if Mary (who had recently turned 40) should get a mammogram.

Of course, this was a trick question. Like the validation-seeking patient I am, I wanted my doctor to say, “Why, no. As a matter of fact, the scientific consensus shows that Mary getting a mammogram is as useful as me waving a magic wand over her tatas.”

Time out for a confession: A part of me (the scared shitless part) wanted Mary to get the damn mammogram. I wanted her to line up like a good 40-year-old, get her boob squished, and get the all-clear sign. Because, like every other woman, I desperately want to believe that breast cancer screening works.

But it doesn’t. At least not the way we want it to work. And, yes, I was being hypocritical. How could I ignore the numbers? How was I different than people who refuse to face facts in global warming or evolution? In my darkest moments, I even found myself gently coercing Mary to get the mammogram. “Why not just get a baseline?” I said in my most sensible, medical-reporter voice.

Back in the doctor’s office, my rational and irrational selves were clearly in a tug-of-war. I desperately needed our doctor to squelch my panic. I needed her to be a bastion of evidence-based care.

So imagine my disappointment when she didn’t skip a beat. “Oh yes,” she said, “go ahead and schedule one. We aren’t going to change our recommendations based on one study.”

Whoa, wait a second. This wasn’t a single study. The new recommendation was the final distillation of more than a dozen studies involving more than 600,000 women. The Task Force is made up of the top experts in the field.

Is my small town doctor really second guessing their work? Or is it just easier to ignore the facts and placate women’s fears?

Last month, an editorial in the Annals of Internal Medicine reminded me of the tightrope doctors walk (not mine, obviously, but others) when it comes to managing evidence-based care with patients’ emotions. As reported by the NYT, the editorial shows “a divide has merged between doctors and patients—with doctors more inclined to accept the new recommendations and the patients wanting to stick to early and annual screening.”

I think it’s time that women (myself included) buck up and face facts about the limitations of mammography. Demanding that doctors practice defensive medicine serves no one, especially women. Mammograms offer nothing more than false reassurances in a world where breasts have come to be seen as ticking time bombs.

Easy for me to say, I will never need another mammogram—one of the few perks of double mastectomy. But I hope that next Fall, when Mary’s annual appointment rolls around, I’ll be calm and rational enough to weigh the facts and give her my blessing…to cancel it.

Radiation Mishaps Make News

As I’ve discussed here, I suspect radiation played a role in the onset of my breast cancer. How big of a role? I’ll never know. But between the ages of 12 and 14, I regularly received blasts of radiation for the monitoring of scoliosis. I don’t know exactly how many x-rays came my way in total, but I do know that protecting my breasts was never mentioned.

Later, as a health writer, I grew increasingly wary of medicine’s willy-nilly use of radiation. My concern escalated in 2008 when I wrote a piece for Time Magazine about the potential hazards of CT scans, especially for children. The basis of the story was two studies indicating an increased cancer risk associated with multiple CT scans. I was blown away to learn that each CT scan packs as much radiation as up to 500 conventional x-rays. Of course, CT scans can be a life-saving diagnostic tool and should absolutely be used when necessary, but my reporting found that they are widely overused.

Not to mention, the operator-error factor. One of the most disturbing tidbits I uncovered in reporting that story was from a CT technician who admitted that even though newer scanners can be adjusted to give children up to 50% less radiation (a standard recommendation), many technicians simply forget to reset the machine.

Needless-to-say, I was thrilled to see the New York Times tackle the issue of radiation safety these past couple of weeks, and I want to help them spread the word. What first grabbed my attention was this article about the lack of radiation safeguards. The people most often in harm’s way? Cancer patients.

Thousands of radiation errors are made every year, many of which are never reported to the FDA. Here are just a few of the most egregious examples from the NYT’s coverage, When Medical Radiation Goes Awry:

  • Patient A had just completed treatment for a brain tumor and received additional radiation intended for Patient B, who had breast cancer.
  • A 31-year-old woman with vaginal cancer was overdosed because of confusion over the method of measuring the strength of radioactive seeds…causing an overdose of radiation to her rectum and vagina.
  • A doctor implanted radioactive seeds in the wrong location in a patient with prostate cancer. The radiation oncologist then failed to promptly interpret a post-implant CT scan, which would have revealed the error.
  • A patient with breast cancer received a 50% overdose for 10 treatments because a wedge (a gadget used to shape the radiation beam) was mistakenly left out.
  • Another breast cancer patient, 32 years old, received 27 days of radiation overdoses (three times the prescribed amount).

Thankfully, I’m not the only person who was flabbergasted by the magnitude of these medical errors. The NYT’s coverage culminated today in the news that the FDA is finally going to “take steps to more stringently regulate three of the most potent forms of medical radiation, including increasingly popular CT scans.” I’m not a big fan of the FDA. I think the agency is spread too thin and given too little resources to get the job done. But, at the very least, maybe, someone is finally paying attention.

Finally…Connecting the Dots

Well, my stint as a professional blogger for Time Magazine is ancient history. Ironically, instead of giving me a burning desire to blog,  it turned me off of blogging for awhile. Not in any theoretical sense, I was just bone tired of cranking out words. Even last month’s mammogram mayhem wasn’t enough to draw me out of my anti-blogging funk. (Maybe because I had so much to say…I just couldn’t begin to distill it down.)

But today is different. Today I want to shout from the rooftops about a recently published article in the New York Times. An article that made me want to jump up and say “Hallelujah!” The op-ed, titled “Cancer from the Kitchen” and written by Nicholas Kristof, is about the connection between chemicals in the environment and breast cancer. Long before I was diagnosed with breast cancer I was frustrated by the lack of attention given to environmental toxins and their role in cancer. Since my diagnosis, my low-grade irritation transformed into a red-hot annoyance. So I was thrilled to see someone at the NYT discussing the subject.

In a nutshell: it’s the estrogen stupid. Scientists have long known that a woman’s lifetime exposure to estrogen is directly linked to her risk of breast cancer. The more estrogen percolating through her bloodstream, the higher her risk of breast cancer creeps. That’s because estrogen fuels rapid cell division in breast tissue and cancer is a disease of rapid cell production.

But what scientists are only now beginning to understand (insert sound of forehead smacking here) is just how much environmental estrogen is contributing to breast cancer rates. More than 80,000 new chemicals have been developed since World War II, states Kristof, but “even of the major chemicals, fewer than 20 percent have been tested for toxicity.” And, since 1975, a woman’s risk of breast cancer has gone from 1 in 100 to 12 in 100.

Many of these chemicals act like estrogen in the human body, meaning they are estrogenic. These substances aren’t esoteric agents handled by people in biohazard gear, these chemicals are in our homes, more specifically they are in our pantries and in our medicine cabinets. They hide in plain sight in our detergents, our perfumes, our make-up, and our plastics. Estrogen swims in the food we eat and the lotion we slather onto our skin. Over the years I’ve written about this topic at length for Health Magazine, Yoga Journal, and others. In doing so, I’ve interviewed some of the top endocrinologists in the country. They’ve been sounding the alarm bells but no one seems to be listening.

Earlier this year a 10-year-old girl in California was diagnosed with breast cancer. (Here’s a link to her blog.) Makes you wonder how bad things will need to get before more people get red hot and insist on a change.

My Radio Debut

An abbreviated version of last month’s blog entry “Pinked” aired on my local NPR station (WFIU) last Thursday, October 29th. (Thank you to all of the Bloomingtonians who tuned in!) The spoken-word version of my essay is a mere 300 words (2 min), but I think I got my point across.

If you’re interested in listening, here’s the podcast.

Warning: clicking on the link will take you straight to the recording, meaning my voice will immediately leap out of your computer. So, brace yourself, adjust the volume, close your office door, whatever you need to do…I found it a little startling myself ; )

PS. Still blogging for Time Magazine (insert sound of panting here…) but sharing the load with another writer, so I’m a wee bit less stressed. Just one more week to go!