So I feel obligated to point out how emphatically I disagree with Dr. Bernadine Healy, former head of the NIH, when she suggests that women should "ignore" the new conclusions reached by the US Preventive Services Task Force. To put it bluntly, there is a reason why "ignore" lives in ignorance. And when it comes to defense of health, ignorance is not bliss—it's just ignorance.
6 questions and answers about the mammogram guidelines
But before we fall into a misunderstanding, let's establish something: The opposite of ignoring something is not obeying. It is, quite simply, considering. Listen, learn, consider—and make an informed choice. The Task Force report (which last week recommended that women can wait until 50 to start mammograms and then get them every other year instead of annually) is not a decree, an order, or an obligation. It is an interpretation of the scientific evidence, based on careful review. Why would anyone ignore that?
What it tells us is that mammography between the ages of 40 and 50 is by no means a slam dunk; there is considerable harm for the good that is done. We can do better—but we are unlikely to if we ignore how we're doing now. Dr. Healy herself notes that breast cancers before menopause tend to be more aggressive and grow faster. She implies this is a reason to keep screening, but it could very well mean something very different. For screening to be of value, it must find a cancer early when it can be treated more effectively than it would be if found without screening.
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When cancers grow rapidly, however, the gap between detection with and without screening tends to narrow, and the benefits of screening decline. It clarifies to go to an extreme: A cancer that grew fast enough to go from completely invisible today, to symptomatic two days from now, could only be found one day early—namely, tomorrow—with screening. A one-day head start would almost certainly not help improve outcomes, and thus screening would be of no use.
It may be that the best way to use mammography to save the lives of women under 50 is to screen more often than once a year. That would increase the opportunity for screening to find cancers before they progress. But that conclusion will never be reached if we ignore the careful evaluations of the screening we are now doing. Similarly, it may be we need improvements in technology—such as digital mammography or breast MRI—so that those fast-growing premenopausal breast cancers are found even earlier, and more reliably.
One easy way every woman can help prevent/cure breast cancer
Whatever the answer, we won't get to it if we don't question the status quo. The Task Force is not telling you what to do, but they are telling you something important about what the limits of what we know, and what we can currently do.
In my opinion, we ignore today's scientific insights at our collective peril, and place the low roof of ignorance over the possibilities of tomorrow.
What do you think about the guidelines? Will you keep getting mammograms before 50?
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