Like many women, I was shocked by this week’s announcement that the U.S. Preventive Services Task Force recommended against routine mammography for women 40-49. I’m a rational, reasonable person, persuaded by hard clinical data, and yet I couldn’t help but think about the women that I’ve known who’ve survived breast cancer because a lump was caught by a mammogram before they were 50. I’m sure that I’m not the only one who knows a story that could bring tears to your eyes.
That’s the emotional, right brain side of me. The rational side of me can see statistics and studies that indicate risks of even low exposure to X-rays, whether from mammography or other sources. My conclusion, and the conclusion that I came to some time ago, is that the benefits of mammograms in this age group aren’t clear. These are numbers, cold hard facts on a page. My analytical left brain accepts that.
But. (There’s always a “but.”)
I am the granddaughter of a woman who had a radical mastectomy at age 46. While my mother appeared to be cancer-free until her death from heart disease at 55, I’ve never been able to get that nagging fear out of my head. Grandmom had what would now appear to be classified as Stage III breast cancer with lymphatic spread. I’d be lying if I said that didn’t scare my right brain.
I know that medicine is constantly evolving, and consensus recommendations change all the time. I also know that for all of the studies, all of the science, medicine is often an intuitive art. More and more hospitals are emphasizing evidence-based medicine, yet there are still broad chasms in approaches to treatment, as demonstrated by the ongoing debate between stenting and bypass surgery to treat coronary artery disease.
Medicine is never black and white. It’s a left brain, right brain balance. As explained by Katherine Chretien in her USA Today column,
Statistics and science give critical grounding for population-wide health decisions. Personal narratives help us understand the human values involved. How much are we willing to spend to save a life from breast cancer? What is the cost of a false-positive test on a woman’s well-being? We need balance.
How do we do this? Better communication, partnership and true dialogue.
Communication and dialogue. These are key elements that are often missing from physician/patient interactions. I can only hope that the recent mammogram recommendations get women so fired up that they start talking — really talking — with their doctors.
So as I see my 40th birthday on the not-too-distant horizon, I’m going to do the only sensible thing: I’m not going to make a decision in isolation. I’m going to talk to my doctor, and together we’ll analyze the available information and weigh the risks and benefits — for me — of mammograms in my 40s. Because in the end, medicine is not about numbers on a page, it’s about the individual.
Great post. I wish physicians had more training in medical school on conveying risks and statistics, basically translating studies to those not in medicine. I think that is greatly lacking. This would make these discussions between individual patient and physician that much better.
I also wish we knew more about individual risk in breast cancer and had a test with better accuracy than mammograms, especially among younger women.
Nice to see a rational discussion on this acknowledging both points of view.