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Mammogram wrap-up

We’re all tired of this topic, and unless I hear something especially goofy from the peanut gallery, this will be my last word on this subject (for the time being, anyway).

We guessed it. Both sides of the Great Political Divide went crazy and blamed either “big government rationing” or “big insurance profits” as the reason for the new paper’s recommendations. Both sides were at pains to say how much they were “for” women (I am too!). Both sides suspected a deeper conspiracy because of the timing of the paper. Nobody stopped to consider that both conspiracies can’t be true simultaneously, and that maybe—just maybe—the people who wrote the article believed what they were saying. Or, even stronger, that its findings might be correct.

Absolutely nobody I heard even made even so much as an attempt at a hint to explain “Why 40?” It’s as if beginning screening at 40 was handed down by sacred tradition, and thou shalt not question it.

Like I said, 40 might even be right for some women, but you can’t know that by any arguments you heard from the press, physicians, government bodies, and medical societies over the past three days. All we got were non sequiturs, illogical emotional probes, distractions, irrelevancies, and on and on. The closest anybody came to justifying the age was “40 saves lives,” which I hope you can agree is no sort of argument at all, merely an appeal, loosely, to authority.

We also heard, in the parade, from a handful of people who said, “The mammogram saved my life.” We did not hear from the larger group of women who never had a mammogram and never had cancer, either. Nor were there any voices from the immensely larger false positive crowd.

So I’ll tell this story again. An otherwise healthy women went for a routine screening and was told “the mammogram found something.” She went back and had another dose of radiation and still there was “something.” Days, weeks passed until the ultrasound. “Will you still love me if I have my breast cut off?” Worry, stress, tears. The ultrasound also showed something, suspiciously not in the same exact spot. Finally, a needle biopsy. Relief! It was nothing! The woman was very grateful, too. She said, “I would not have known I didn’t have cancer had I not gone through all that.” My argument that she could have saved herself all that grief had she just assumed, as was rational, that she did not have cancer; after all, she had no risk factors. She got angry with me for suggesting this. She wanted to know.

Since I have a cruel streak, I told her that she could still have cancer after all, because even biopsies are not perfect, and besides, the entire breast wasn’t sampled, just one spot. So she couldn’t actually know, she still had to rely on probability and statistics. Plus, that biopsy and all those x-rays have actually increased her risk of future cancers and other infections.

This was an email exchange and after my last comment, I never heard back from the woman.

Update Another oft-heard argument is that if we change the screening age to 50, we will miss a lot of women, from 40-50, who have cancer that could have been detected had they had a mammogram. This is true, but irrelevant; for, by the same logic, we can justify screening to start at age 15. Why? Because, of course, if we don’t start at 15, we will miss a lot of women, from 15-40, who have cancer that could have been detected had they had a mammogram.

But to say “start at 15” sounds absurd, doesn’t it? It is. And the reason it is, is the very same reason, or reasoning process, that went into the new recommendation of 50. You have to balance the costs—the actual high and very real costs—of false positives, the costs of false negatives, treatment capacities, and the important (but infrequently mentioned) base rate of the disease (per risk groups, usually; those with a family history vs. those without, etc.). This is a perfectly quantifiable calculation, and the paper’s authors came to conclusion that 50 strikes that balance. Maybe this is wrong, but they went about it the right way, and kept politics out of it.

Update I made a point to listen to Charles Krauthammer tonight. He was spot on, as his many columns usually are.

8 thoughts on “Mammogram wrap-up Leave a comment

  1. I am astounded after reading the new guidelines that the Dept of Health wants to implement concerning breast cancer screening. How many women will lose their lives because of the stupidity spewing forth ! I was diagnosed in 2000 with breast cancer.I had had a suspicious mammogram ,then a cone magnification to be certain it was a tumor ,followed by a lumpectomy ,confirming it was cancer. Thankfully ,it was ,as my surgeon said the “best” kind to have. Lobular carcinoma in situ.It was not in my lymph nodes. My mother however wasn’t so lucky and died from breast cancer in 1990. My uncle in the 50’s had to have a breast removed due to breast cancer. These idiots offering up this dribble need to know men die from breast cancer .I have lost aunts and cousins to it also.And now women in this country are being told to wait until they are 50 to have the first baseline !! My daughters were told to go to Cleveland Clinic and have a baseline done,in their 30’s We were told that. Cleveland Clinic has one of the few Rhodium filters ,used during a mammography,lessening the radiation.

    There are 12 different kinds of breast cancer.Much more is involved than just finding a lump. Many young women die from inflammatory breast cancer each year.How many women are willing to take the chance and let testing slide…If anything ,MORE mammograms are desperately needed!!!
    It boils down to the government not placing much of a value on our lives. Let’s cut the costs,cut the mammograms ,biopsies,lumpectomies and kill em off. So livid ,I can hardly type. This hits too close to home for me..

    La Porte ,Texas

  2. Thanks, Nina.

    You didn’t tell us at what age you were in 2000. But it appears you have a family history of cancer, a significant risk factor, and which puts you in a category where earlier and more frequent screenings are advised.

    Can you tell us whether you have any sympathy for those who have false positive experiences?

  3. “These idiots offering up this dribble..”: I don’t know the “idiots” in question, but I did know the people who ran a big British project in this area 30 years ago. They were the very opposite of idiots, and came to much the same conclusion – mass mammography of the kind then advocated does more harm than good. Of course, they knew they would have to deal with mass irrationality from stupid or over-excited people. That’s par for the course when dealing with “mass” anything.

  4. Krauthamer is certainly a very sharp, informed and incisive commentator. It was a shame he screwed up the % of false positives. He probably just mispoke.

  5. Given the astonishing news of (purportedly) hacked and leaked e-mails and other files from the Central Repetition Unit for Global Warmmongering, I woner if you can tell us anything about using statistical methods to help assess the validity of alleged e-mail leaks?

  6. Bernie,

    He did misspeak. He was actually giving the change of having cancer given a positive test, which is related.

  7. I was 53 years of age in 2000 That was not my first lump.It was my first and last malignancy in my breast Yes ,we went through anguish of waiting for the results from the cone magnification and then the aspiration several times over. But my alternative was to just “forget” it when a new lump was discovered and risk that it was breast cancer. My mom waited to late to be tested and she died from it. I had a bilateral mastectomy in 2000 and reconstructive surgery six months later. The mastectomy lessened my chances of ever getting breast cancer again to 1.4 %. Excellent odds for me.. Yes ,I have sympathy for those who get “false positives”. But I have more sympathy for the families of friends ,who waited too late to be checked.You might have some anguish over a false positive. But one thing is for certain-it’s not going to take your life.Make give you some short term grief ,but you’ll get through it.

  8. Nina, so glad your treatment was successful and wishing you many wonderful years ahead. However, your thesis is not supportive of even your own anecdotal experience, whereas women are being advised that the benefits of mammograms performed in their forties are too limited to warrant the requirement of the procedure. The proposed relaxing of the recommendation to 50 year-olds would have been just as successful in your case and since you didn’t mention your mother’s age, I will assume she was past 50 when here cancer was detected and 40 year-old testing would not have helped.

    Respectfully I’m compelled to ask, Did I miss something in your relating of your experiences that would have made a case for mammograms during the 40-50-year age range?

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