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What is a woman in her 40s to do?


Susan Grossman November 20th, 2009

After living under the specter of breast cancer complete with the laminated self-examination card hanging in her shower for the past decade, she commences with a right-of-passage: the annual mammogram...

After living under the specter of breast cancer complete with the laminated self-examination card hanging in her shower for the past decade, she commences with a right-of-passage: the annual mammogram at 40. Here is something more powerful than the monthly please-don't-let-there-be-anything-there sweep of fingertips that will give her some reassurance that technology will detect, or not, abnormalities in her breast tissue. After all, we have had it drummed into our beings that it is only a matter of time before you or someone you know is going to get breast cancer!

Now, she is informed that mammograms can wait until she is 50 and then, she only has to go every other year to get one. Oh, and self-exams are not that effective either and only cause greater anxiety. What? This is counter intuitive to the reign of terror we have lived under since the advent of "pink outs" and "running for the cure" that grab us by the throat and shook us in the Nineties.

The 16-member U.S. Preventive Services Task Force certainly is doing its job, basing its recommendation on statistics. Numbers tell the story in no uncertain terms. Specifically, the task force found that one cancer death is prevented for every 1,904 women age 40 to 49 screened for 10 years. There is one death prevented for every 1,339 women age 50 to 59 and for every 377 women age 60 to 69.

The chairwoman of the task force, a professor of biomedical informatics at Arizona State University, is quoted in the New York Times saying she knows the new guidelines will be a shock but "we have to say what we see based on the science and the data." That's a true research scientist for you.

Naturally, the findings ignited a firestorm on both sides of the debate. Then, Kathleen Sebelius throws more gas on the fire. The U.S. secretary of health and human services comes out and says keep doing what you are doing.

I've been asked during the last several days about my thoughts on these new recommendations. Tiny cancerous calcifications were detected during my own routine mammogram five years ago when I was 42. I've been a bit peeved by some comments that women like me are an anomaly. Really? What would my future be if I were yet to have had the screening that ultimately led me to undergo a double mastectomy? I had no known risk factors and was then, as I am now, in excellent health. Under the new guidelines, I am still two years away from my theoretical first mammogram.

Chemotherapy was not recommended for a number of reasons I won't go into. But I talked with an oncologist for reassurance. She told me it was her job to study the latest research and interpret it for her patients in order to provide them the best care possible.  "Don't listen to other people who do not know you and your situation," she said. "Listen to me."

I was comforted by her words and I am hearing her today. Good advice for us all. We know ourselves and our doctors know our medical history. Talk to them and together decide what is best for you. Save your energy for the next debate which is likely to be insurance companies using these guidelines to ax payments for mammograms until we turn 50.

Grossman, a Norman resident, is former managing editor of Oklahoma Gazette.

 
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