We Asked for Input, Now We Have It
What do women want? I mean, what do women really want--besides, say, a magic thin pill, men who will commit and world peace?
According to recent news reports, we want the doctors in whose hands we place our health and confidence to tell us in no uncertain terms exactly when we should begin having mammograms and exactly how often.
If doctors can’t (and they can’t), then we are going to roll our eyes, cluck our tongues and characterize them as a bunch of insensitive wimps who don’t have the decency to make absolute recommendations even in the face of unpersuasive data.
Why, the nerve.
Never mind that we’ve spent the last few decades complaining about our doctors’ God complexes, resentful of the omniscient poses of medical professionals--mere mortals, we often remind ourselves, with advanced degrees.
But now they have done what we’ve been agitating for all along. Now they have told us to study up on breast cancer screenings, consult with physicians, then decide for ourselves when to start.
And so we accuse them of abandoning us.
An oversimplification? Not if you happened to read last month’s front-page story about the National Institutes of Health’s attempt to come up with a standard recommendation about mammograms for women in their 40s. If you did, you probably came away confused. It was the intellectual equivalent of watching a tennis match: On one hand this, said the experts, on the other hand that. As I finished the accounts, the great, all-purpose cliche of the news business came to mind: “One thing is certain: Nobody knows anything for sure.”
Well, we do know one thing for sure: Women 50 and older definitely benefit from regularly scheduled mammograms. No one disputes this.
As for fortysomethings, the federal advisory panel convened by the NIH refused to make a blanket, one-size-fits-all recommendation about routine mammograms. The chairman of the panel said that women between 40 and 49 should be provided with “the best information about the risks and the benefits” of mammography and then decide for themselves.
Personally, I’d camp out in my radiologist’s office if I could. Forget the discomfort involved in a breast X-ray (and it’s not too high on my list of pleasurable experiences); I’d have a mammogram a month if they’d let me. I’m the only woman I know who has tried different brands of soap in an effort to nail the perfect breast self-exam. That’s how worried I am about this disease. And that is why, in the absence of a cure or an astonishing advance in early detection, the panel’s recommendations are heartening to me. I want to make this decision for myself. And I want to make it often.
And yet, warns one breast cancer surgeon, “The downsides [to mammography] are not minimal.” Risks include exposure to radiation, which, said the surgeon, “will cause cancer in a certain low number of women.” There is also the risk of false positive readings, which, according to this expert, “will scare you to death and lead you to unnecessary surgery.”
That, it turns out, is not what the Self-Empowerment Generation wanted to hear. One of the NIH panelists, a statistician, told a newsmagazine he’d received “hateful voicemail messages suggesting I was trying to kill women.”
The American Cancer Society was none too happy, either: “We find it especially troubling that the panel would issue a pessimistic statement and conclude once again that the burden of decision for a woman in her 40s is hers alone.”
Heaven forbid we should have scientists making pessimistic statements about breast cancer. Although relatively few women in their 40s will be stricken with breast cancer, it is, after all, the leading cause of death for that age group. And while we all want happy news about cancer, the fact is that over the last 60 years, mortality rates from breast cancer have barely improved at all.
“This year was the first year we had a change in the mortality rate,” said breast surgeon Susan Love in an interview Monday, “and it was only 1%.” When it comes to scientific advances in the study of breast cancer, the woman who wrote the book on it (“Dr. Susan Love’s Breast Book”) simply said: “We have no home runs.”
And because we have no home runs along the lines of, for instance, the new blood test for prostate cancer, Love said, we are reduced to what strike some as pointless battles over screening recommendations.
“People are confusing public health policy with individual decisions,” Love said. “There is not enough data to say every woman over 40 should get mammograms, and to pretend it’s there just to assuage people is wrong.”
This, however, did not stop the United States Senate from passing a nonbinding resolution, 98-0, in the wake of the NIH report supporting routine mammograms for women in their 40s. (Soccer moms, your clout lives on.)
For years, women have sought control over their health care, have battled to have their doctors include them in the decision-making process. Now, a panel of experts has declared that this is exactly how it should be--for a certain segment of women, for a certain kind of health care.
That so many have reacted with anger suggests a deeper emotion at work: fear. This is understandable when we speak of cancer. It seems to me, though, that the NIH panel has done women in their 40s a favor. We’ve always wanted the truth about mammograms. Now we have to be able to handle it.
* Robin Abcarian Her column appears on Wednesdays. Her e-mail address is rabcarian@aol.com.
