Screening and Mammography: The Real Story

Part 1: A Patient’s Perspective

By Cathy Bueti, Author of Breastless in the City

I was 31 years old when I was diagnosed. I found the lump myself. The dense breast tissue—common in someone of my young age—prevented the mammogram from clearly revealing a tumor.  An excisional biopsy in my case revealed Stage II breast cancer. Mammography is not a good screening tool for most young women because we often have denser breast tissue. A radiologist told me that the results of my annual mammograms are nearly impossible to read for that reason which leads me to question why I am having them done. There is also the concern among health professionals about the effects of radiation exposure in young breast tissue from these medical tests.  This concerns me as well. In addition, mammography can find cancers that may never be life threatening if left untreated, yet once identified by a mammography, these cancers will be aggressively treated. This is a facet of cancer that I think has not been talked about nearly enough.

The months since the U.S. Prevention Services Task Force (USPSTF) initially announced new recommendations for mammography screening have been filled with many emotionally driven debates from both the medical profession and people living with breast cancer. I think that there needs to be fewer debates driven by anger and more action to reduce mortality rates in young adults.   There needs to be a greater focus on finding more effective screening tools for the young population.  I believe that using an ineffective tool for lack of something better gives a false sense of security to the many women fearful of getting this disease.  As a young breast cancer survivor, I have no doubt that I am in the minority when I say that I supported the new guidelines from the get-go.

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A BCA Commentary
by Angela Wall, Communications Manager

The USPSTF guidelines were initially drawn up under the Bush administration in 2002, with an intended audience of clinicians rather than patients and the general public. The revised 2009 guidelines were released to the public, however, during a major U.S. economic crisis and amid efforts by the Obama administration to introduce national health care reform legislation. This release was badly timed and badly managed, resulting in a mangling of the issues. Waves of fear swept across the nation, having nothing much to do with the science-based evidence that produced the USPSTF guidelines, but having something very real to do with the state of women’s health care in the United States. And as often happens in such a media maelstrom, the voices of those who actually had something to say that was worth hearing were drowned out by the mainstream.  The greatest fissure these guidelines reveal is the social inequities that exist in our country: the divide between the health care haves and have nots.

Government-funded annual mammogram and screening programs offer many women who live without health insurance access to health care on a regular basis. Federally and state funded annual screenings mean an annual trip to a health facility of some kind, which in turn provides access to medical practitioners. During these annual visits, other health concerns can be addressed.  A discussion of the scaling back of mammograms amid the budget crisis and health care reform understandably left many in the African American community, for example–where breast cancer occurs at younger ages, and often more aggressively–feeling abandoned and concerned that once again systemic racism was valuing cost savings over the health needs of African Americans.

Amid the distress over cutbacks and death sentences, critical discussions about the ability of mammograms to actually prolong women’s lives in these communities were, for the most part, ignored.

When it comes to discussing health issues, emotions run high. After all, it’s people’s lives we’re talking about. However, during the “mammography debates,” among the press and many breast cancer advocacy groups, these emotions drove the debate. We can’t let that happen again. When we are presented with science-based evidence, we have a responsibility to examine the recommendations carefully.

Existing screening methods are inadequate. We need screening technologies that do more good than harm; we need technologies that can reduce mortality rates.  We need to address health inequities so that women of color and women of limited economic means have the health care they need to live longer lives. We need screening techniques that effectively detect the more aggressive types of breast cancer that increasingly are present among African American women. We need to find more effective screening tools, because what we have is simply not good enough.

Current mammography screening technology is not a panacea for breast cancer. And it’s certainly not a stand-in for adequate health coverage. The recent outcry against the USPSTF guidelines reveals that many incorrectly believe that it is.

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