The NY Times has been reporting for the past two days the newest recommendations from the U.S. Preventive Services Task Force on when, and how often, women should have mammograms. Just this afternoon, Secretary Sebelius came out to assure women to ignore the USPSTF's recommendations and instead 'do what you're doing'. Clearly her statement is in response to the incredible backlash the panel's recommendations have created.
I find the backlash puzzling. The panel's recommendations say to get screened before 50 if you feel like you should or if you have a medical/family history that indicates an increased chance of getting cancer. The reality is that mammograms are not preventive. They are diagnostic and they aren't foolproof. I think it is amazing and wonderful that modern science has meant that many women who would have died have been saved, but let's look at this realistically. It is not the mammogram alone that has saved lives. It's important for all of us to have good relationships with our bodies and our doctors to come to our own conclusions about when to test and for what.
And then there is the accusation that this recommendation is all about saving insurers money. That may be true, but the reality is that mammograms are a huge moneymaker for the health care industry. We have a for-profit system that requires profits to be made at all points. It could be that those against these new recommendations make money off of mammograms (radiologists, clinics, medical equipment manufacturers and suppliers) and stand to lose money. It could also be that those who are presumably for the new recommendations will make more money (insurers). Personally I'd like us to take the profit-motive out of health care and start basing our system on quality of care and life. Are we healthier? Are we happier? Are we more secure? Are our lives more fulfilling and peaceful?
I turn 40 next year and I will talk to my doctor about whether or not I should have the test. I believe that we can come to the right decision together. Meanwhile...
I wish we would spend this much energy on actual prevention, such as:
- Regulating industry. Right now our waters, our air, our land, our food, and many of the products we use every day contain known carcinogens. Just a couple of months ago this paper ran a series on our polluted waters and also a story on the link between pesticide use and brain cancer in children.
- Cleaning up already contaminated places and working to prevent future contamination. We have a 'dead zone' at the mouth of the Mississippi that is larger than 100 square miles from fertilizer and pesticide run-off. Those same fertilizers and pesticides are in our earth and in our waters. We have problems of sludge and slurry, PCBs, lead, and dioxins throughout the country, not to mention the increased radioactive pollution around nuclear power plants, something else that was written about in these pages recently. We should demand that our country be cleaned up and work to prevent more contamination.
- Looking honestly at our own lifestyles and habits, from what we eat and how much we exercise, to what products we put on our bodies, use in our homes, and how much plastic we surround ourselves with. We know that many plastics are dangerous in the short-term and all have long-term disposal problems. If we saved plastic for it's unique, necessary uses, and stopped using it in meaningless, throw-away products, we could prevent our future generations of girls and women (and men and boys) from suffering and also lessen our immediate risk right now. People are still microwaving food in plastic containers and drinking water and soda from plastic bottles, most of which were not refrigerated during their transport, even though we know that plastic + heat = dangerous. Additionally, we are burning all types of fuel, a horribly dirty process, to fire our cars, our heaters, our electricity, etc. We should reduce our usage as efficacious individuals and learn to live with less energy to ensure that we pollute less.
- Reviewing our family medical history and our personal history with our doctors in an honest way and learning to live with the anxieties this review may cause. This will help us be more diligent in our lifestyles and will make us better equipped to make proper diagnostic and treatment decisions. If we really don't want 'bureaucrats' of either the public or for-profit persuasion deciding our fates for us, we need to take responsibility and control of what we can.
Beyond this, I hope we push for more research on better, safer diagnostic tests for all cancers. Whether we accept or ignore these recommendations, the reality is that we need to take an honest look at how we live and begin to make changes. Otherwise, medical research and study will be playing endless catch-up.