See? I am not the only one who thought of this.

Not exactly on topic... but here is an article on a dispute between a non-profit hospitol and a non-profit insurance over how much stuff should cost. The hospitol says it needs to get 30% more.

http://www.bellinghamherald.com/northwest/story/1166688.html

Oh, people are freaking out over this and making it seem like the task force made much more definitive recommendations than they actually did. Evidence-based practice is a GOOD THING. The only sane response I've read was this article:

http://www.nytimes.com/2009/11/19/opinion/19collins.html

Women who want annual mammograms will still be able to get them.

I think what would really change the technology for screening would be for doctors to check for testicular cancer the same way they perform mammography.

Yes, because sitting in a cold office with a doc fondling your grapes isn't uncomfortable already? Prostate screenings are fun I'm sure too.

"Using the whole fist doc?"

This is a tough one. I personally know two women who were diagnosed with advanced breast cancer AFTER they had annual mamograms. One of them was a nurse. Both of them found the cancer after feeling a lump. It was not caught by the annual mammogram. One is still alive, three years after disgnosis and as far as I know, cancer free, so far. The other one made it almost five years after initial treatment before she had a reoccurance in her bones and died less than 4 years later. I think what a lot of the alarmists fail to realize is that there are many forms of cancer of the breast. Some of it is very aggressive and some of it is not. Here is where the catch comes in. For the less agressive forms of breast cancer, which grow slowly, it is often possible to wait until a lump is visible before treatment, remove the lump, with no follow up chemo and never have a reoccurance. This form of breast cancer is unlikely to kill you. For the agressive form of breast cancer, it spreads very fast and this seems to be why it is not detected well with the annual mammogram. This form will kill you quickly and the earlier it is treated the better off you generally are but like I said I know two women who have had that form and neither woman had it detected by the annual mammogram. When you add it the fact mammograms may actually cause some cancers to develop, it is very much an individual judgement call as to which women need more agressive screening and which don't. I see the revised guidelines as bringing breast cancer screening more into line with screening for colon cancer. If you are high risk because of genetics then by all means have it done more often, if you aren't, then don't. I really don't care what the various warring medical associations recommend because there is a very lucrative screening industry and almost all insurance pays for it so there is a huge incentive to get women to screen even if they are very low risk. If people were paying for this sort of thing with their own dime, it would remove all of the ethical questions. If you think you need more of it, buy it. Isabel

Sio, you got that right.

"The next level is the public health policy level, where we as a society have to decide what tradeoffs we're willing to make to save a life that otherwise would have been lost to breast cancer."

I contend that this sentence constitutes an abuse of the phrase "public health". There is no public health concern here -- breast cancer isn't contagious, nor is it spread through contamination. If Amy wants to evaluate the risks and costs of what age she should start and/or discontinue getting regular screenings, it's her business and whatever she decides has absolutely no impact on me.

The problem is that the current Administration wants to make it my concern, by setting up health care as a zero-sum game. Then, if I support Amy getting regular screening, I might just be denying screening for my own wife or some other woman close to me, because if Amy gets more, then some other woman has to get less. Or worse yet, if I someday become one of those rare males who contracts breast cancer, then by supporting Amy getting more screening, I may have signed my own death warrant.

Something to consider, Mammograms are far less effective for younger women who tend to have "dense" breasts. If you are high risk, and young you may want to use alternative forms of imaging (some options are MRI - more expensive, and ultrasound - less expensive).

Exactly Cousin Dave. This is a cost issue, not a public health issue. Some fool woman was on NPR yesterday twisting herself in knots trying to explain why NOT having a mammogram is more likely to save your life: "The public health will be better served by using these resources in a more efficient way." All that means to me is that I'll be expected to use my money to pay the medical bills of a stranger whom a bureaucrat has pushed to the front of an extremely long line.

The key concept here is opportunity cost.

Health care dollars going to cancer screening are dollars not going to something else. So the real question is whether the benefit to those women under 50 outweighs the cost everywhere else.

Cousin Dave highlights this, perhaps unintentionally. There is no such thing as breast cancer screening for men, despite the fact that men occasionally die of the disease who might otherwise be saved.

Why? Opportunity cost.

For asymptomatic women, the emotional stress involved trumps any benefit, but that's my decision. Breast cancer is not one of the cancers that can be cured anyway (like skin cancer), so what's the point of finding it? Early, late, the outcome will still be the same. 'Treatment' only adds a month or 2 to your life, and the treatments aren't exactly benign.

I can have all the mammograms and invasive exporative surgery I want up here in Canada, but I've opted out of the whole thing because I have zero risk factors (neither hereditary nor environmental), and I don't need to live with that kind of stress. I've got very fibrous breasts, so I'm a prime candidate for lots of testing, and I don't want my boobs butchered.

Like the doctor said, it's up to the individual woman to decide what her stress tolerance is.

Politico had an interesting article on this. they point out that none of the experts on the study group were oncologists. If you are going to do a study on any form of cancer shouldn't at least one of your panel members be someone who treats cancer?

This blog is very timely for me.

Needle in the boob? I'm not sure what you're talking about, so I looked up mammograms to see if there was some new technology I haven't heard of.

It appears that it's still done the same way it was on the first and only time I had one done. For me, and some other women I guess, it was painful to the degree I decided I would never do it again until they find a new method.

Dying doesn't particularly scare me. This Sunday is my birthday. I'll be 54, as old as my mother was when she died. Oh, she had her mammograms, was always fighting the ten pounds or so of excess weight, kept her blood pressure and cholesterol under control. She and my stepfather had bought some land in New Mexico and a motorhome for their retirement, la la la.

In her last June, they found out she had a brain tumor. Did their operations and chemo and she was buried that October. She joked about finally losing those ten pounds.

Death couldn't take away her sense of humor. I hope I handle it as well.

To the LW from yesterday--that was 29 years ago, when I was 25. I just found out I still get choked up about it.

So fuck mammograms, fuck dieting, and fuck worrying about it. We're all worm food in the end.

Of course, that's just me.

Depending on the form -- there are now several treatments that can effectively bring the cancer's growth to a halt. (They are estrogen blocking drugs.) There are also drugs that target breast cancer cells.

Breast cancer is no longer a death sentence.

What Jim said. I saw some stats on this recently. The survival rate (by "survival", I'm assuming they mean the cancer goes into remission) for breast cancer is now about 60% -- still not great, but a lot better then 40 years ago, when it was below 20%.

As a woman who has -- knock wood -- put breast cancer behind me, I first off want to say: Chrissy you are an idiot.

Second, Cousin Dave the 60 percent stat includes really old women, and really old people of both genders tend to get cancer of one kind or another. Survival rates are much much higher if women over 70 are excluded.

Third, my own cancer didnt show up on any mammogram -- and I went in for one because I felt the lump when I was nursing. That makes me extraordinarily lucky because nursing moms don't normally get mammograms. In fact, 15-20 percent of breast cancers don't.

Still, I have mixed feelings, since as a woman who got cancer in her 40s I now know far too many women in their 30s and 40s being diagnosed with BC. I just asked my oncologist the other day if she thought this was a result of later childbirths. We already know delayed childbirth increases risk but I'm starting to believe having a child late does, too. My doc didn't dismiss the idea out of hand (and no telling what all those hormones to help older moms get pregnant will do to them down the road).

Yes, we'll all be worm food one day. I'd just like that day to be as far from today as possible.

Sorry. . .15-20 percent of BC's don't show up on mammograms, is what I meant. False negatives are more dangerous than false positives.

Regardless of my "fuck mammograms" statement, I'm not trying to discourage women from getting them. Obviously, most women don't react like me. If everyone had the same experience I did, those things would be used in torture chambers.

One of the articles I read today said some women found mammograms to be painful. Well, lucky me. I used to think I had a pretty high pain threshold, but it was hard not to scream before I got out of there.

Before rational thinking kicked in, I felt betrayed. Like if was an initiation trick women pulled on each other, you know--"Go on! It doesn't hurt. We all did it, go on! Mmmooohahahaha...)

Further information, about 75% of biopsies are benign. Right now it is the most expensive part of the cancer screening process. Radiologists (that I know of) biopsy if they think there is a greater than 2% chance that a lesion is malignant. So, right now work is being done on improving alternative screening methods to reduce biopsies and therefore reduce cost.
The majority of the the patients I know of have very good prognosis if the cancer is caught reasonably early, so it is well worthwhile to be screened and to do self exams. If mamograms are too painful for you, talk to your doctor about other options. There ARE other options, so don't stop screening just because of the pain.

When did you have your mammogram -- before or during your period? According to doctors you should try to schedule r9ght after your period.

Are you relatively flat? Its harder to get them "laid out".

Was the x-ray tech old & experienced, or some young grad?

Breast cancer isn't a death sentence. How idiotic. I made an earlier post to this that isn't here now, so I'll repeat it: I know 4 women under 40 with breast cancer either currently or in their past. One is 34, and stage 3. I know a 35 year old man who had a heart attack. All these people aren't worth saving, evidently, even though they have more years as productive taxpaying citizens than a 60 year old.

You think this idea is bad, how are you going to react when Obamacare outlaws hormone-based contraceptives?

Which they will no doubt do if a conclusive link between estrogen and breast cancer is proven.

It'll be great to watch the "keep your laws off my body" crowd react when the official answer from the Office of Comparative Effectiveness Research is "barefoot, pregnant, and in the kitchen".

which could lead to the really interesting headline of "Mrs. Obama in the west wing, with a candlestick."

I'm glad I'm not the only one who thought this was a precursor to nationalized health care. Between this and the new pap smear guidelines (and frankly I think Brian is on to something as well) we can all get used to getting less, and paying more.

I had a baseline mammogram at 35, but frankly, I'm not at risk for breast cancer and I'm not really all that concerned about it. I AM at risk for colon cancer and will be screened for that regularly.

If you want more than you're allowed, you'll have to pay for it. Get used to it, because I suspect under Obamacare it's only going to get worse.

PP writes: "Regardless of my 'fuck mammograms' statement, I'm not trying to discourage women from getting them. Obviously, most women don't react like me."

And getting back to the point: You've made your decision, and whether I agree with it or not is irrelevant because it's none of my business. And it needs to remain none of my business.

The best article that I have read about this is at Slate.com. People really seem to dismiss the risk of false positives leading to a lot of unnecessary treatment. To me that is a huge risk that should be avoided for the almost infinistmal improvement on detection from receiving a mammogram before age 50. I should note that I am in the low risk category.

"To me that is a huge risk that should be avoided for the almost infinistmal improvement on detection from receiving a mammogram before age 50. I should note that I am in the low risk category."

Those dying prior to age 40 are very comforted that you want to save people a needle prick biopsy, I'm sure. Most breast cancer is not linked to any risk factor at all, you know that, right? Having the gene only accounts for-I think-roughly 25% of the cases.

Momof4 - It's even LOWER. 5-10 percent of cases where the gene is present. 80 percent cases have no clear risk factor.

"You think this idea is bad, how are you going to react when Obamacare outlaws hormone-based contraceptives?

Which they will no doubt do if a conclusive link between estrogen and breast cancer is proven."

Perhaps. There seems to be a strong link between use of birth control pills and a *decreased* risk of ovarian cancer (basically, each ovulation increases your risk of ovarian cancer slightly; by stopping ovulation, your risk of cancer is reduced). Ovarian cancer is highly treatable IF it's caught early. However, because there is no good mammogram-style test for it and its symptoms mimic those of a thousand other normal-human conditions (bloating, abdominal pain, etc. etc.) in the early stages, it typically isn't caught until much too late in the process for highly effective treatment. So, using hormonal contraception may raise your risk of developing breast cancer, which is highly detectable, but lower your risk of developing ovarian cancer, which is not highly detectable.

I consider that an acceptable tradeoff. Whether politicians looking to cut costs would consider it an acceptable tradeoff is another matter; after all, one of the most expensive things you can do as far as the state is concerned is live for a long time after you pass out of your prime earning/taxpaying years.

(That having been said, I think an attempt to ban hormonal contraceptives would, in face, get women to rise up in revolution. With pitchforks. And torches. Don't mess with an armed horde in the throes of non-moderated PMS -- it's ugly.)

More details here: http://www.cancer.gov/cancertopics/factsheet/Risk/oral-contraceptives

If you want more than you're allowed, you'll have to pay for it. Get used to it, because I suspect under Obamacare it's only going to get worse.

No, if you want more than you're allowed, you'll have to break the law to get it. Because in order for the government to control costs, it has to control all access to health care.

Which means your political affiliation coild be a life or death choice.