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The Canadian Task Force on Preventive Health Care says self-examination of the breasts is of little utility.
Photo credit: ©2011 Thinkstock
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New guidelines for breast cancer screening that recommend women avoid routine mammography until age 50 are based on faulty methodology and will result in an "untold number of lives lost" if implemented across Canada, the Canadian Association of Radiologists charges.
The guidelines, released Monday by the Canadian Task Force on Preventive Health Care, recommend against routine mammography screening for most women age 40 to 49, arguing the "harms and costs of false-positive results, overdiagnosis and overtreatment" outweigh any "significant reductions in the relative risk of death from breast cancer".
Aimed at settling more than a decade of contentious debate over the recommended frequency and value of breast cancer screening, the guidelines also say that clinical breast exams and self-exams have no benefit and should never be undertaken, and urge that women over 50 only have mammograms every two to three years, instead every one or two.
But critics say the data on which the guidelines are based is dated.
The recommendation against routine screening of women under the age of 50 who are at average risk of developing breast cancer risk is self-admittedly "weak," and based on "essentially antiquated" and "unbalanced" evidence, argues Dr. Nancy Wadden, chair of the Canadian Association of Radiologist’s Mammography Accreditation Program and medical director of the breast screening program for Newfoundland and Labrador. "The task force looked at studies that were over 25 years old [involving] equipment that is outdated and not even available anymore. There's been enormous changes in breast imaging since that time, [and] in addition radiologists' interpretation skills have improved tremendously."
Part of the problem is that randomized control trials have only been conducted on analog mammography, "because digital hasn't been around long enough," adds Dr. Christine Wilson, medical director of the Screening Mammography Program at the British Columbia Cancer Agency.
Wadden contends that more recent observational and community studies indicate that there are "definite benefits" to screening younger women using digital mammography.
This is the kind of news report that makes my blood boil, triggering a sickened, terrified feeling that bubbles up from deep within.
The powers-that-be have once more muddied the waters in the realm of women's health care and disease prevention. Oh, and it won't be the first time! I'm old enough to remember the time - and this went on for years and years - when medical studies "proved" that hormone replacement therapy protected women from heart disease. In many cases it was prescribed to middle-aged and older women for that reason alone.
People listened to this without questioning it, doctors adopted it as policy, and all went merrily along, with uncounted women dropping dead from heart attacks due to "unknown" factors. Maybe heredity? Inability to handle stress? If doctors even looked at the fact that these women had been on estrogen for ten or fifteen years, they simply did not see it, demonstrating the bizarre blindness all too common in what passes for women's health care.
Then someone bothered to do a study. But it had to be halted in a hurry, because the women taking the estrogen were dying of heart disease at an alarming rate.
Yes, that's right. Dying.
Can a task force be wrong? Can studies be flawed? You bet they can. Already charges have been levelled that the data in this ludicrous study came from dinosaur technology, analog equipment that is now obsolete. We don't even watch TV like that any more, so why is it OK to do life-or-death studies the same way?
But what sets my brain on fire is the insistence that women should not go to their doctors for a routine breast exam at regular intervals unless there is raging breast cancer in their immediate families. And it gets worse. The breast self-exams that I've been told to do every month - yes, every month, not every two or three years - are now strongly discouraged on the grounds that it may lead to that horrific possibility, a "false positive".
This, the study insists, will only lead to unnecessary anxiety about nothing. We'll just worry our pretty little heads. We'll get all upset about losing a breast, like women do. If we think we feel a little lump, or for that matter a big one, we might (silly things!) become afraid we have cancer and be dead in a few months, then rush off to our doctors to get a professional opinion.
The answer? Don't do the self-exams.
For years and years (and years!), I felt infuriated about being badgered to DO the exams after every cycle. Like most women, I felt tremendous guilt about forgetting to do them. The message seemed to be that the onus for early detection was on us. If we missed a lump, if one somehow turned up at our yearly checkup, well then. . .
The implication was that we could have done something about it much, much sooner if we'd only had the sense to know our own bodies.
That was back in the golden days of "Our Bodies, Ourselves" and the seizing of women's health care back from the patriarchy. But now I don't know what the hell is happening. It's as if I am being told NOT to know what is going on in my own body, in my own breast tissue, so I can tell what's normal and what isn't.
Why? The answer seems to be, it's better not to know. It only upsets us. We fret. We trot off to doctors. We even insist on mammograms, which have vague negative side effects that no one ever spells out.
Want to know the real reason?
Dollars. It costs the medical system to give us those tests.
Never mind how much it costs us (though having a cancerous lump slowly and insidiously grow from barely perceptible to Stage 4 without our awareness might just cost us a little.) It costs the system to deal with these pesky little "false positives". I don't know how much; I don't have figures. But since this so-called study appears to be deeply flawed, yet is STILL being pushed at us as gospel, I feel a hidden agenda at work.
I've had bullshit statistics rammed down my throat for too long. Whenever the conclusions on women's health care suddenly lurch into reverse, I notice there is never an apology for the confusion and dismay and anger it causes. We're simply updating what "we" know.
Save me from this "we". It doesn't exist. "We" is Orwellian, a herd thinking that is always extremely dangerous because it is so often based on bias, not to mention bullshit. I honestly don't know how "statistics" like this can even be released, let alone followed. Would you walk into Future Shop and try to buy an analog TV? Isn't breast cancer just a little more serious than that?
My worst fear is that next time a woman tries to book a mammogram, she won't be allowed to because she's considered too young, or not enough time has elapsed since the last one. Or perhaps doctors will begin to say, "No, I won't do a breast exam on you until you're over 50," leaving us to cope with that pea-sized lump we weren't even supposed to detect.
A breast exam at a doctor's office takes about a minute, maybe two. How much does that cost the system? If there's a "false positive" and the patient has to go for a mammogram and finds out there's nothing there, the result for her is immense relief. Why would the system want to take that away that peace of mind?
Ludicrous! The whole thng is ludicrous. And to me, it smacks of a not-so-subtle wrenching of control away from women and back to a medical system that has let us down time, after time, after time. Why does this bother us so much? Why do we get all anxious and whiny and trot around doing "unnecessary" things to protect ourselves?
Because women die, that's why. They die. And we don't want to.
How often have I heard that most women find cancerous breast lumps themselves? I don`t have statistics rattling around in my head, but I`ve been hearing it for decades, quoted as an unassailable fact. If it`s true, and I believe it still is, how on earth can any study, anywhere, be so primitive, so flawed, so horribly disrespectful to women's wisdom and women's right to manage their own health care? Worse than that, how can the medical community blandly swallow it as accepted procedure?
I want an answer to one more question.
If all this disrespectful garbage becomes policy, which it may well do, how many small lumps will go undetected because we're really not supposed to touch ourselves there?
How many significant lumps won't be detected because our doctors will politely tell us they don't do breast exams any more until we are well past menopause?
How many deadly lumps will go undetected because our mammogram clinic will suddenly refuse our request for a screening test?
To conclude, I can`t help but make the inevitable analogy to men's health care. My husband had a possible cancer scare a couple of years ago. Now, every six months, he goes in to see a specialist who does an uncomfortable manual test on him, just to make sure everything is still OK.
Applying the rules of this new study, he should not be going in because the exam might lead to a false positive, which could cause him "unnecessary anxiety" (read: which could take up the doctor's precious time). Instead, he's given the exam, mostly for his own peace of mind.
I hate this stuff, I really hate it. It stirs up fury in me. Fury because women are going to die from this, to actually die. Even one death is too many, but my intuition (and haven't we been told for years to listen to our intuition?) tells me there will be many. It's the health care system instructing a woman to stick her head in the sand, because it's really better for everybody if she doesn't know.
But there are certain advantages to being dead, aren't there? The best one is, you can't complain.
http://members.shaw.ca/margaret_gunning/betterthanlife.htm
