One Life Saved

I know I just wrote about breast cancer screening and how the more technologically advanced we get the more we see and perhaps the more invasive we are becoming with our treatments. But I just have to talk one more time about the recent controversy with mammography screening. I’m not sure I can fault the panel for doing what they were asked to do. The job of the US Preventative Services Task Force is to systematically review evidence of effectiveness of preventative measures and develop recommendations for clinical preventative services. Although the panel is appointed by the government, they are an independent panel of experts from mainly primary care along with prevention. Interesting to note the current panel has only one woman as a member. So when I say they did their job, I believe that to be true. The intentions were good. We certainly don’t want to be putting people through a lot of supposedly preventative tests and procedures if they are not useful and could even be harmful. But I think these current recommendations take that a step further.

The new recommendations are that women should not start having mammograms until the age of 50 and then at that point, until they are 74 years old should only have mammograms every 2 years. The reasoning behind the recommendation is that the panel felt, based on the evidence available, that perhaps unnecessary harm was be inflicted on women. This harm came in the form of unnecessary biopsies being performed and the extreme anxiety a woman may have while waiting for results after a mammogram picks something up. I can certainly attest to the fact of the second point. When I had a mammogram see something and had to go back for the diagnostic mammogram then the ultrasound, then to the surgeon for followup and finally to interventional radiology for the fine needle aspiration, it was grueling. Of course, being an oncology nurse and seeing the worst of the worst, I could only imagine what each second ticking away was affording this supposed intruder in my body. Luckily everything was negative for me. Not the same for many people. The same day these recommendations came out my mother was diagnosed with breast cancer. I was sure that the lump the mammogram found was nothing. They most often are. And she has had a history of benign cysts. But not so this time. She also, waited for the diagnostic, the ultrasound, the appointment with the surgeon and finally the surgical biopsy of the lump. But this time it wasn’t good news. And now we wait again to see what the next steps are. Extreme anxiety. Absolutely. But do we try to spare people this period of extreme anxiety by closing our eyes to the possibilities? By pretending that there couldn’t possibly be anything there so why stir up trouble. I don’t really believe the ignorance is bliss theory should be put into play when knowledge could potentially save even one person’s life.

The point the panel makes about potentially unnecessary biopsies is also valid to a point. Certainly there are a number of women who have gone to biopsy only to find a very minute mass that was indeed benign. Talk about a relief. I know in my own circumstance I was glad to have an “unnecessary” biopsy. In the many other times my mother had “unnecessary” biopsies we were ecstatic. I’m not sure why they would be considered unnecessary if they do what they are meant to do: confirm or deny the presence of cancer.

The panel points out that evidence shows that mammography potentially can prevent one death for every 1,900 women between the ages of 40 — 49, one death for every 1,300 women between the ages of 50 – 59 and one death for every 377 women between the ages of 60-69. And this seems to them to be minimal. But look at the numbers. There are about 150 million women in the United States. If we can prevent one death for each of the age groups listed, that could potentially mean 41,000 deaths. And isn’t it interesting that the American Cancer Society estimates over 19,000 new cases of breast cancer in 2009 and 40,000 deaths. Now of course these are broad guesses and large numbers. But even if we go back to that one person whose death was prevented, is it not worth it? Can we give up on that one person?

I know you’ve all heard of the outpouring of disbelief that came with these recommendations and the thousands of calls that were going into radio stations and television shows and government agencies from women who were diagnosed with breast cancer in their forties thanks to a mammogram. Can we ignore that? Luckily most of those people who make that sort of decision are regarding the panels recommendations as just that, a recommendation. No one is changing their guidelines, no one is rushing to change what they tell their patients and life is going on. My fear is for that one woman under 50 out there who has been afraid to get a mammogram or has just put it off and now has even more reason to do so. What harm have we potentially done to her and the rest of the women like her? Get your mammogram.