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PrintBreast Cancer Screening and the Power of Choice
“Political correctness was okay, until they started to convince people that it was entirely possible to pick up the clean end of a turd.” Uncle Bart
Christmas is a wonderful time of the year, especially because that’s when families get together. But the holiday season can be really stressful. Why?
We all change as we grow up. You might have a sister who married a Baptist and moved to Texas to work for an oil company, while your cousin is in San Francisco working for an alternative lifestyle magazine. They’re sitting at the same table with the brother who watches FOX News every night. Do not mention Sarah Palin or Obama. Resist the urge – unless it’s boring and you want to liven things up a bit.
Many feel that they no longer share anything in common with their relatives. Well, they do: their genetics. Right now you’re probably looking over at your gassy slurping Uncle Bart thinking, geez….really?
How about breast cancer and family history?
According to an internationally well-respected professor of genetics at the University of Iowa Medical School, (my sister-in-law —yes, trying to score points with the family) , one is at higher risk if they have a first-degree relative (mother, sister, daughter, or male family member) with breast cancer that is:
- Early-onset (pre-menopausal)
- Bilateral (both sides)
- Aggressive type (infiltrating ductal)
- Multigenerational
And that’s not all. Our behaviors, including smoking, alcohol and medications change the risks.
So how about those recent breast cancer screening guidelines from the US Dept. of Health and Human Services’ panel that’s been all over the news lately? (Take a look at the USPTSF Web site at www.hhs.gov.) Did that say anything about family history? Uh, not really, kinda, sorta, maybe…. ?
“The USPSTF recommends against routine screening mammography in women aged 40 to 49 years. The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms. “
Boy, might as well shout “Bruno!” at that dinner table.
What the panel is saying is that the cost of yearly mammograms, the danger of radiation exposure and the number of negative biopsies is enough to outweigh the practice of routinely obtaining a mammogram every single year, in all women, at least without putting some thought into it. From a purely economic and epidemiologic view, they may have a point.
Although their intentions were good, the actual effect of the panel recommendations may not be. The very real fear is whether insurance companies will begin using the new recommendations to refuse coverage for any mammograms under 50. Using such “national guidelines” will they, (and eventually government sponsored plans), determine who gets what, based on overall national costs rather than individual needs? Some argue that when we try to be all-inclusive, such as universal healthcare, there may be a price to pay—an emphasis more on guidelines rather than individuals. News flash: it already happens now, with private insurance payers.
If a patient has a sister with breast cancer and smokes two packs a day, I’m not waiting until 50 to get a mammogram. Yet many breast cancers that I’ve diagnosed were by screening mammography, in healthy women younger than 50, with no family history. The guidelines are helpful for physicians to have an overall view, but every patient is different. Thankfully, for now, we can still decide what’s best for each individual. We can choose.
There’s a great sense of irony to all this. Fiercely independent rugged individuals forged this country, with freedom as being the one binding quality for all Americans: freedom to say what they want and to believe in what they want. And that’s why stress at the family holidays can be inevitable. Because of freedom, we are all different.
Thus, the visceral reaction to the mammogram guidelines reminds me of other well-intentioned issues. As the only Asian kid in an all-white high school in the 70’s, I was subjected to many things that would be considered politically incorrect today – hurtful, but not damaging. I understand that PC today would have made my life then more bearable, but I survived and assimilated.
I wonder about what happens when we try to make those diverse folks sitting at the dinner table give up even simple freedoms? To be able to say “Merry Christmas and God Bless you” with reverence, grace and truly good intentions, without feeling guilty you didn’t say “Happy Holidays?”
To sum it up, Uncle Bart said,” Political correctness was okay, until they started to convince people that it was entirely possible to pick up the clean end of a turd.”
Good ol’ Bart. Have a Merry Christmas with your diverse families and remember: We’re all still Americans, which means we have freedoms, which means we’re all different, which then stresses the heck out of each other over the holidays. And we still love each other no matter what, because we are family.
