I think I am angry. NO. I know I am angry. A woman I knew who had been suffering from an aggressive form of breast cancer passed away a few weeks ago. She was young, in her forties. Such a waste. She had three boys, the youngest a sophomore in high school.

She is just one reason why I have chosen to walk for the Avon 2-day Walk in Boston, MA.

Although I am pissed about her needless death, I am also angry and frustrated with the news about revised recommendations for screening mammography. The U.S. Preventive Services Task Force (USPSTF) announced late last year that not only should screening mammography be postponed for women at average risk until they turn fifty, but that physicians and other healthcare providers should not promote patients perform self-examination.

The reasons are understandable to a degree, I guess: harmful effects of mammograms can include false-positive results, false reassurance, and, for some, pain during the procedure. Experts also cite a possible risk of radiation exposure. To be fair, the guidelines do recommend that physicians access their patients' risks and explain both the benefits and risk associated with annual mammograms. But the plain truth is, if the professional organizations don't recommend them, then insurance companies won't pay for them. I am not sure I understand the logic: health care to treat patients is much more expensive than preventive measures. 

Since coming out with their revised recommendations, USPSTF has been "under fire" from other professional organizations, including the American Cancer Society and the American College of Radiology, both of whom are refuting these new guidelines. And I understand why. Since screening guidelines were put in place, the percentage of woman diagnosed with breast cancer in earlier stages--and thus more treatable stages--has consistently risen. According to a November 2009 article in Medscape News, "studies have shown that breast cancer mortality decreased by nearly 2% per year during the 1990s, which was largely attributed to the benefits of screening. For women younger than 50 years, the decline was more than 3% per year. Since mortality rates peaked in 1989, a woman's risk of dying of breast cancer has decreased by 29%." The article also notes that in the early 1980s when relatively small numbers of women were diagnosed by mammograms, the tumors found were on average 3 cm. By the mid-90s when approximately 69% of women in the United States were being routinely screened, the average size tumor was 2 cm, representing earlier detection and thus better treatment options.

My question is: Why fix something that isn't really broken and risk the chance of breaking apart families? Although I concede there is some risk to the false positives, etc, it just seems to make more sense to recommend the screenings, thus making it more accessible to most women via insurance. Before the exam, healthcare providers can explain the risks and benefits and let the woman make an educated decision. And really, where is the true harm to self-breast examination? I just cannot wrap my head around that logic. 

My friend left three children, a loving husband and countless friends. She had a few additional years because she caught her cancer through self-breast examination and was able to endure aggressive treatment. For a while, she was "fortunate" to celebrate life again -- even hosting yearly parties to celebrate her additional years. Then her the cancer came back. If her physician had cautioned against self-examination, would she even have had those last few years? I guess we won't ever know, but I sure don't want to find out if/when it happens to someone else.