So... I guess I need to warn you that this is not a typical post for me. It's probably gonna be long. But I hope you'll hang with me because it's really important. It's one of my soap-box issues. And it just might get ugly... I've worked almost 25 years to tame this she-beast within, but oh! When her feminine sensibilities are disturbed, she oozes from my pores and I'm helpless to contain her.
And maybe I shouldn't.
I'm just sayin'.
Some things are worth getting... ummm... ugly... about.
I first caught wind of this news from a blogging friend {my blogging friends are not only hip to good music, but are on top of medical issues, too!}... and today, I heard more on this in the news.
I guess I should preface with the fact that in another life, I was a physical therapist. Well, I still AM a physical therapist, just not practicing. This is important only because the graduate school I attended was so BIG on basing information on proven.scientific.facts. Like, don't even have a thought unless you can site a reputable source that publishes only well-organized research that withstands the scrutiny of well-known peers and professionals in the scientific community. This means a whole lotta stuff, but I'm afraid that if I go into it, I might loose you on account of boredom. Yawn.
Also just as important to know is the fact that I'm a mother {yes, I know you knew that! I'm just sayin'.}, and by default, this makes me an advocate for women. All women. Because someday, she will be a woman.
It's just that right now, she's very busy being a little girl. So I'll worry about this big stuff.
This is what I heard in the news today:
The average woman does not need to have mammograms until she is 50, and then, only biennially.
And also? Those breast self exams we've been encouraged to do for the last, I don't know, 20 years? Don't do those, either.
Hmm.
So... Yes. I heard this on CNN's Headline News. And, Yes. This IS typically my news source. Only because they give me what I need to know quickly. Like, in little quippets. I no longer have the time to listen to 30 minute dissertations on a story, or to hear two opposing super-gurus debate the topic, or to flip back and forth between the conservative and the liberal news stations so that I can form an opinion on my own. I don't have time for that. Any more. I am not in any one place long enough to do that! So, HLN it is.
But this just didn't sit right. I came home and researched. And researched. And researched some more (click on the links to see my sources - I've been properly trained.) And again, yawn, to save you the time and interest, I'm putting it to you as the thoughts came to me. It's a little more digestable that way.
First, though, this is my mom.
She would probably be pretty upset to know that I published a photo of her from Christmas morning... without make-up, or her hair properly done, because she is my southern mama. But I wanted you to meet her. She used to smoke a pack of cigarrettes a day... but she went cold turkey... about 18 years ago. I never told her, but I am so proud of her and her strength, to be able to do this after 33 years of smoking!
Back to the news story. My thoughts kinda went like this:
~WHAT?! WHO said that?
Why, it was the USPSTF*. That would be the 'United States Preventive Service Task Force' which is sponsored by the Agency for Healthcare Research and Quality, and it is not to be confused with the United States Government. Even though it says United States at the beginning. Kinda like "natural flavoring" that is not at all natural, but a chemical that is called "natural flavoring". {Get my drift??} You can read more at that link, but know this (taken directly from the above site):
"The USPSTF reviews the evidence, estimates the magnitude of benefits and harms for each preventive service, reaches consensus about the net benefit for each preventive service, and issues a recommendation.
The Task Force grades the strength of the evidence from "A" (strongly recommends), "B" (recommends), "C" (no recommendation for or against), "D" (recommends against), or "I" (insufficient evidence to recommend for or against)."
Also important to note: this task force is weighing the 'magnitude of benefits to harm' of the said procedures... ie: is it WORTH it? And they specifically mention "for the average woman". We ALL think we're average, don't we? Who is the average woman? This average woman subject is never described.
~Well, who EXACTLY makes up this task force??
Private sector physicians and other health care providers, though it seems they all work in an educational setting. Prestigious educational settings. Like Cedars-Sinai, John Hopkins, Darmouth, and Mount Sinai to name a few.
~WHAT exactly did they do? How was their research conducted? Did they use scientific method? Were there control groups?
It seems, I think, that they reviewed literature, though it's not exactly described and no articles are sited.* HOWEVER, this paper, the results of their endeavors, is published in TODAY's Annals of Internal Medicine. HeLLLo?? A well-respected publication in the medical community.
Hmmm.
Well... then... all that sounds ... reputable. Proven. Scientifically. Except for what they actually did. And except that grading thing. What exactly is THAT?
"The Task Force grades the strength of the evidence from "A" (strongly recommends), "B" (recommends), "C" (no recommendation for or against), "D" (recommends against), or "I" (insufficient evidence to recommend for or against)."
Recommendation against annual mammography for average women 40-49 {that's me, btw}: grade C. See above... "no recommendation for or against". ?? So, I guess that means that a recommendation FOR annual mammography for these same women, based on the review of unsited literature, can be made with the same strength.
Recommendation for biennial mammography for women 50-74: grade B. Hmm.. a little stronger than neutral.
Recommendation against health professionals teaching women breast self-exams (BSE): grade D. See above... "recommends against". So, they make a recommendation and then recommend against that??
It's all unclear at best.
And by the way, here's a picture of my sister:
She's 42, and a school teacher. She loves my children, and my other sister's children like her own. She lives near my parents, the only one of the three of us who does, so she is a daily part of their lives. {And btw, she also would not be too pleased with my publishing her undone Christmas morning picture-you'll keep my secrets, won't you??}
And here's my baby sister {also on Christmas morning... kinda got in a groove here!}:
She's 39 and married to her high school sweetheart. They have two beautiful little boys who are 9 and 6 years old. She loves to cook, and they live in a beautiful historic farm house in Main. She gardens, too. In this picture, she's hugging the automatic garage door opener that her husband gave her for Christmas because it's what she really wanted. This kind of luxury when you live in snowy cold Main is indescribable!!
Also, the reasons sited to NOT have an annual mammogram or to do self-exams is because they found too many false-positives. A false-positive is when you falsely get a positive result. So, assume a woman finds a lump on BSE, but upon further testing, is found to have only fibrotic tissue. The lump found on BSE would be a false-positive for breast cancer (but places that woman into a higher-risk category for developing breast cancer, and thus alerts her and her care providers to take necessary precautions). The USPSTF suggests that these false-positives create too much stress, and lead to unnecessary biopsies and other medical procedures.
Ummm. Sorry. Would rather stress over possibly having breast cancer and find out that I don't, than to not test and find out that I do. Just SAYIN'. And the biopsy... the pinch of a needle to tell me: yes, you do; go get treatment, or no, whew! PLLLLeeeeaaasssse.
Here are my real concerns:
-Other busy moms like me heard "No need for mammograms 'til you are 50, and then, only do it once every 2 years!!" and "DO NOT do those self-exams anymore!!"
-Insurance agencies are going to grab this info, and tell us, "Sorry. No need for this anymore because this very professional-sounding, government-sanctioned-sounding task force said you.don't.need.it. Not medically necessary, so therefore, we ain't payin'." And even though this report STATES that it is up to the individual woman "and her values" as to whether or not she should have mammograms, she may not be ABLE to if her insurance stops paying for it.
*****
The American Cancer Society responded immediately to the USPSTF recommendations with this awesome article - worth reading. They continue to recommend annual mammography exams and clinical breast exams (CBE) for women aged 40 and above.
They estimate that 40,170 women will die from breast cancer in 2009. That's 4.58 women per hour. Every hour. Every day.
Get your annual mammogram. Do your own MONTHLY self-exams. Become familiar with your body so that you can notice changes (this includes changes in your skin), and discuss these changes with your gynecologist or family physician (or dermatologist).
If you dread going for your mammogram, do something to make it fun. I go with a friend and we make a day of it... including lunch and shopping.
Go during the off-season :)... spring. It takes me 20 minutes from my parked car to my parked car! October (Breast Cancer Awareness Month) and November are the busiest times of the year.
Think of your daughter... your mother... your sisters... your friends. Don't believe everything you hear. Do your research. Take care of yourself.
ADDENDUM (11/18/09): Because this has been all the news today, I went back and reviewed the USPSTF article. I found their list of 32 references. All articles can be found, and many read in full through the link for the Annals of Internal Medicine above.
Also given toward the end of the article, and don't know how I missed this at 2am last night while sipping on my wine to calm my inner she-beast, the USPSTF lists recommendations by quite a few well-respected agencies in the medical field. The American Cancer Society (2003) recommends annual mammograms beginning at age 40. So does the American Medical Association (2002) and the National Comprehensive Cancer Network (2009), but these two organizations also recommend BSE. The American Academy of Family Physicians recommends annual mammorgrams beginning at age 40. The Canadian Task Force on Preventive Health Care (2001) and the American College of Obstetrics and Gynecology (2003) recommend mammography every 1-2 years beginning at the age of forty. These include ALL AGENCIES the USPSTF reported on with the exception of two. Information is not given on the recommendations of the other two agencies for women between the ages of 40-49.
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