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December 03, 2009

New Tomdispatch


Not So Pretty in Pink
The Uproar Over New Breast Cancer Screening Guidelines

By Barbara Ehrenreich

Has feminism been replaced by the pink-ribbon breast cancer cult? When the House of Representatives passed the Stupak amendment, which would take abortion rights away even from women who have private insurance, the female response ranged from muted to inaudible.

A few weeks later, when the United States Preventive Services Task Force recommended that regular screening mammography not start until age 50, all hell broke loose. Sheryl Crow, Whoopi Goldberg, and Olivia Newton-John raised their voices in protest; a few dozen non-boldface women picketed the Department of Health and Human Services.  If you didn’t look too closely, it almost seemed as if the women’s health movement of the 1970s and 1980s had returned in full force.

The rest.

—Jonathan Schwarz

Posted at December 3, 2009 05:43 PM

There's more information here too:

Posted by: Jenny at December 3, 2009 09:26 PM

Barbara Ehrenreich is the best.

Posted by: N E at December 4, 2009 01:07 AM

Finally, some SANITY!

Posted by: Rupa Shah at December 4, 2009 09:27 AM

The one thing they never tell the public is that mammography causes cancer. The exact numbers are difficult to measure, since the radiobiology is extrapolated from Hiroshima and Nagasaki cancer data, thus crude estimates. But there's no doubt that screening women who don't need screening causes a small number of cancers. MRI is a better tool, more specific and sensitive for early lesions, without the risk of radiation, but it's far too expensive for screening.

Somewhat unrelated, but in about 20 years we're going to find out the effect of irradiating large numbers of people with CT scanning. Although radiologists are trying to make their non-rad colleagues aware of the risk of arbitrarily ordering CT scans, the number of scanners has skyrocketed since around 1995. The radiation dose of CT compared with plain x-rays is significantly higher, especially when performed on 16 or 64 channel units. Large hospitals often have multidetector scanners in their ERs--good for trauma and "rule-out MI or PE" cases, but bad for all the other people, kids included, who get scanned for minor trauma, abdominal pain, headache, etc.

(Unless you're a believer in so-called "radiation hormesis):

Posted by: Terumo at December 4, 2009 10:14 AM

"The cancer-industrial complex."

Posted by: Marcus at December 4, 2009 10:25 AM

I would like to clarify that my previous comment does not mean, imaging for early detection of cancer is not indicated. My comment was regarding how the author brought up some issues which are not discussed but which are well known to MDs. One should NEVER underestimate the real fear in a woman of getting breast cancer and its implications, real dilemams facing the MDs and patients regarding imaging, treatment options ( there is no universal treatment as medicine is not an exact science specially in this situation ) when it is diagnosed and their outcomes are undetermined.

"The cancer-industrial complex."
Marcus, if I may, this is a bit too simplistic, specially in this situation.
When an important medical scientific paper is read at a meeting or published in a reputable journal, MSM is supersaturated with the story. Many times, the general public becomes aware of the so called breakthrough ( does not matter whether it is a new drug or a procedure or an imaging technique ) earlier than a regular practising MD and it can be VERY demanding. Of course, the MD can educate her/himself and educate the patient whether it is indicated and necessary or not. However, there are situations which fall in the grey zone and and MD may succumb to the pressure from the patient ( also trying to avoid any malpractice lawsuits ). So things are NOT as simple as they sound. Also, in practice of Medicine, there can be genuine difference of opinion regarding modality of treatment. In my field, we have guidelines to follow....for a specific condition, A treatment modality is absolutely indicated, is absolutely contraindicated and there is that grey zone again where enough data is not available and each MD is left to make a decision based on best judgement for that specific patient.

ps Some of the points the author has made regarding her own treatments need a greater discussion but no one would be interested in reading a thesis!

Posted by: Rupa Shah at December 4, 2009 01:21 PM

Rupa -

Actually, I at least WOULD be interested in reading a thesis. It never stops NE!

Posted by: Aaron Datesman at December 6, 2009 12:15 PM

I believe I heard Ehrenreich recently tell Terri Gross in some other context that commodification of the entirety of the life-world results in a kind of social cannibalism.

There can be little doubt that whatsoever else it could be described as, 'breast cancer' is a commodity. There are 'trade' organizations, technologies, medicaments (and snake-oil) suppliers, advertizers/commercials, all the hallmarks of a booming, entrepreneurial enterprise.

This dispute illustrates to me the process of such cannibalization.

Posted by: woody at December 6, 2009 01:18 PM

Please do not tell me, I did not warn you!

If what I write seems complicated and convoluted, unfortunately that is the way it is. In medicine, nothing is straight forward.

To begin with, mammography is definitely indicated in a specific high risk group, starting at 40 when a woman has family h/o breast Ca in maternal aunts. There is another group of women who are at high risk who have severe FCD and have never been pregnant. And what the advisory group is saying is only 'guidelines'. Each MD will have to make a decision based on her/his patient's history. So to make blank statements as to whether one should get screening at specific age or not is contrary to sound medical practice. I wish and hope, every woman reads the guidelines first before jumping to conclusions or anyone tries to underestimate what is at stake for a woman who belongs to high risk group ( and indicates indirectly even that early screening is not needed ).

As the author herself has mentioned, the risks of HRT were not known before yr 2000 ( however risks of giving eastrogen therapy e.g. stroke, venous thrombosis, uterine cancer have always been well known ) and she took the treatment voluntarily. In fact large studies indicated, that HRT prevented CHD, probably Alzheimer's and Osteoporosis + Post-Menopausal symptoms ( common indications was prescribing the Rx). For her to use the word 'propaganda' seems a bit excessive. MDs can treat their patients only with WHATEVER information is available to them AT THAT MOMENT. As new evidence is available for or against the treatment, the practice changes. In any case, it is always with the patient's informed consent. Once it was known that HRT resulted in many delayed complications, the nurse practitioner DID HER DUTY to her patient by refusing to refill her prescription without a mammogram and as luck would have it, the author's Ca was diagnosed ( some women continue to use HRT in spite of knowing the risks as their symptoms from post-manopausal syndrome make them extrelely uncomfortable and then of course the MD has to monitor them for complications ).

The author's question regarding her Ca and radiation exposure does not mention for how many yrs she had been having the mammograms. Yes, any radiation exposure is not good however, it is a matter of risk/benefit ratio. Also, I do not know her definition of a "dubious" mammogram. Unless the radiologist strongly suspected something, he would not have done another one ( where one may need to take pictures at different angles and with much higher pressure as the suspected lesion may not be superficial but rather deep and if the woman is obese or has large breasts ). She probably did not need additional test as occasionally an ultrasound of the lesion may be needed too! For past many years, with advanced technology, exposure to radiation is reduced substantially for mammography. So her question "So did I get breast cancer because of the HRT -- and possibly because of the mammograms themselves -- or did HRT lead to the detection of a cancer I would have gotten anyway?" would be difficult to answer for anyone. And THAT is THE DILEMMA facing every MD and patient.

At one point, Ultrasonography was being used without any thought in the first trimester of pregnancy as it was considered safe and without side effects. Of course, without long term studies, one can not be certain and now, it is done ONLY WHEN INDICATED ( one would hope so ).

ps if you google 'HRT treatment Nurses study', you will come across tons of studies that give you information on this subject, one in particular......page1

Posted by: Rupa Shah at December 6, 2009 03:49 PM