Mammograms

I am so confused! When I first heard the recommendation to begin regular screenings at age 50 instead of 40, I thought, "o.k., whatever."

But then I watched CNN and listened to NPR, and I thought it was a plot by insurance companies to avoid paying for the test.

Then I watched more CNN and listened to more NPR, and now I'm (almost) convinced that it's appropriate. I'm torn though. It's true that to treat this statement: "mammograms reduce breast cancer deaths by 15% among women ages 40 to 49" as if it was insignificant is offensive.

However, it's also true that the types of cancer that young women get don't require mammograms because they are aggressive and typically detected in other ways. It's also true that regular screenings between 40 and 50 lead to false positives and many unnecessary biopsies and even unnecessary surgeries.

On the other hand, how can you weigh unnecessary medical procedures against death? Especially the death of relatively young and usually otherwise healthy women.

On the other hand (can I say that again, or have I already used both hands???), it's also true that healthcare costs are skyrocketing and part of the reason is unnecessary tests, AND, if we want to control costs, we have to eliminate unnecessary tests.

AND, if I support Evidence Based Medicine, which I do, then I have to accept that this panel considered the evidence and presented the science-based conclusion: regular mammograms prior to age 50 is not the best practice of medicine!

(These issues are summarized in an excellent column by Dr Susan Love on HuffingtonPost.)

Besides the pros and cons of science and evidence, the bottom line is that this is upsetting for me to contemplate - apparently the #1 fear of women my age is that they'll die and leave their children motherless. Check.

I guess the only reassuring thing in all this is that clearly it's stirred a lot of emotion in a lot of people (not just me) because it's all over the news (even Larry King had a segment tonight).

ADDENDUM

On my shuttle bus this morning, two women were talking about this and essentially dismissed the panel's recommendation for totally different reasons - one because she's been getting mammograms since she was 35 becasue that was her doctor's recommendation and one because she apparently never follows her doctor's advice anyway!

I was struck by the reported response of Dr Susan Love, who said we should be more concerned about the causes of breast cancer as opposed to fighting over when to begin routine mammograms. Hmmm.