New breast cancer screening guidelines spark debate

I think this is analogous to whether to have insurance of any kind or not. Taken as a whole society, it is rather irrational for individuals to have insurance-- the evidence is that insurance companies make a substantial profit. So for the whole group, the cost of insurance is not rational.

Likewise, it may not be cost effective, both in dollars and stress, to screen marginally risky populations for breast cancer. For the unlucky individual, however, it may be extraordinarily important.

Are these recommendation motivated by care or cost? Every day we see more collusion between profit and health care. It's difficult to take the word from many authorities including the CDC, FDA, NIH, etc when the revolving door to the private sector erodes any real basis for trust. It's all about profit people!

We can reduce the incidence of breast cancer to nearly zero if we just remove the breasts of all women over 40. So if the goal is to reduce breast cancer to zero this should be our policy. Otherwise we need to talk about numbers and relative value without passion. Hard to do when you speak of 'BREAST" or 'CANCER"

Breast Cancer panel - makes the case for universal health insurance -- whether to have mammograms before 50 is a decision that should be made by a woman and her physician.

Mammograms don't always detect lumps, small or large, nor do sonograms. The best way to take care of yourself is to know yourself and to talk with your doctor.

Seems rather fishy that these "new findings" are coming prior to the possible overhaul of our healthcare system.

After not doing regular self-exams, and going without a mammogram for three years I found a large lump in one of my breasts while adjusting my bra. Was 50 yoa at the time and the lump was 5cms x 3cms. Had I been doing regular self exams and gotten my yearly mammograms the lump would have been found much sooner -- it was malignant and the cost of treatment was by far much more expensive and traumatic than had it been found earlier.

Why are we going backwards on this? The recent medical recommendation is to teach wellness, and that means being intimately aware of our bodies so that we are able to detect changes that may or may not be significant.

Just when we were making this a standard part of teaching teens and young women about self-exams we are now having to expend valuable time and energy to fight this a mysterious new "study."

D.

Mammogram helped me further target the lumps that I felt and as did my attending physician. It turned out to be benign which was a relief for all concerned. I was then only 40 and the same for my younger sister who also did her own breast self examination and like me had the lumps removed which were also benign. She was 42 then. However, it was not so fortunate for my neighbour who was told to do so only when she was 50. By the time, the lumps were detected from her first time self examination and mammogram, she died within 3months of the discovery and whilst the doctor tried to aggressive treat it (she was on her second treatment).

Better to overdo it then not!

Under these guidelines, my bilateral breast cancers found four years ago would not have been discovered until several years from now -- perhaps too late. Please explain to me and to those who love me how this is any kind of benefit. Thank you, and statistically yours, Catherine Nelson

When "statistical mortality on a large scale" is discussed, do they not realize that the "statistical mortality on a large, even universal, scale" of human beings = 100% ?
With or without a deadly disease such as breast cancer -- or even worse, the recurrence of breast cancer -- there will be death sooner or later. [Once I heard a researcher talking about prostate cancer, saying all men die either from it or with it.] INTERPRETING "statistical mortality on a large scale" is a highly complex matter, and even a "slippery slope". Saving women from EARLY death, from a disease that CAN be fought, is a worthy calling of medicine, & a short-sighted interpretation of statistical information in order to interfere with medical care does NOT further a noble cause.

Yesterday's interviewer accused the pro-report doctor of being patronizing to women -- since the only drawback HE could cite to over-screening or over-diagnosis seemed to be that women would be anxious about the word "cancer" and might be scared to have a biopsy. Your first guest also said that as a primary-care doctor HE finds that patients are upset about the possibility of having cancer. What kind of argument is that? People also find it creepy when they learn that there are millions of microscopic mites on their eyelashes! The answer is patient education -- and this report is NOT a good example of patient education!

As your segment made clear, if YOU are the blip on the screen whose life may be saved by screening, YOU care whether or not YOUR doctor recommends YOUR being screened...& whether or not insurance will pay for it. Thank you for a great segment: and thanks to the many medical organizations and personnel who have been unfazed by this badly-managed announcement of a dubious set of recommendations. Sincerely,
Martha Nagy

Re: breast cancer
I heard a great interview on this yesterday on All Things Considered [& wrote a complimentary e-mail about it], and as usual, Larry, YOU were very much on top of YOUR interview on this topic today -- of course!

Good point that it is somewhat analogous to the prostate cancer conundrum -- although I don't think the death rate is comparable at present [?] The news story SHOULD have been simply that unfortunately there is no "cookbook" approach to either of these cancers...that alas! Neither screening nor self-exam is always as predictive as we would like [or PSA tests for men], that there is no exact "If x then y" that will always work, and that at an early stage we are still not completely sure which tumors are deadly & which aren't.

Both yesterday's NPR & today's KPCC shows had PRO-report guests [yesterday's was a doctor from UCSF] who illogically noted that many breast cancers ARE found with self-examination -- with women who have come to their doctors with palpable lumps [your anti-report doctor also rightly pointed out that a palpable lump is by its nature large enough to be felt & therefore possibly more advanced]. YET NEITHER yesterday's nor today's PRO-report guest seemed to notice that each had agreed with the guidelines -- don't teach self-examination -- but when asked how to find cancer WITHOUT mammography, answered that women might find lumps on their own!

Your anti-report doctor was excellent, and callers who were cancer survivors -- pointing out how crucial screening can be, and how important to have an early baseline mammogram -- made fine contributions. The comments on this page also express fair suspicions about the report's connection to the COST of treatment. What a shame that there was no time to ask the PRO-report doctor -- who has evidently been a cancer survivor since age 45 -- how HER cancer, which she has survived FOR NOW, was diagnosed and treated.

Today's show, though, sadly indicated to me a difference in TONE between the two sides. The ANTI-report doctors and others sound as if they wanted to help and cure patients, saving and extending lives one by one, in face of a very deadly and somewhat unpredictable disease.
Yesterday's PRO-report doctor was unclear, illogical & perhaps hypocritical "unawares" -- but today's PRO-report doctor & PRO-report call-in RN added an arrogance & superciliousness to the argument, as if to say, "WE understand statistics & you all don't!"

If you'd like to share your mammogram insights and experiences with our health reporter, please click on my name above to see the questions we're asking. Responses are confidential and help shape our news coverage. Thanks!

I have a problem with the wording of the first sentence of this article. I think mis-interpretation of the guideline is what causes all the confusion. What the new guideline really says is that not ALL women need to have annual mammograms under the age of 50. Whether mammography is needed is a decision between the woman and her provider. It should be largely dependent on the woman's risk factors.