The Breast Cancer Follies

Let’s say there are 630,000 people living in Lee County.

And let’s say half of them are women, which numbers about 315,000 human beings with breasts, or soon to have them.

I happen to appreciate women as a general rule — young, old, black, white, tall, short, country, city, rich, poor, liberal, conservative, political, apolitical, good, bad — and even those who speak French. So this is a wonderful statistic for me, a cause for celebration. American women, do not stay away from me. (Some very foolish Canadians wrote that old rock ‘n’ roll line I just paraphrased, and as much as I also like and respect Canadians, I think they’re wimps for giving up on the best women in the world, admittedly sometimes demanding — American women. But that’s another column, and I’ve already written it.)

Let’s say that of those 315,000 Lee County women, about 35 percent, or 110,250, range in age from 20 to 50.

These are very loose numbers based on my quick glance at Lee County demographics, and they could be off by 2 or 3 percent, or 20 or 30 percent, or even 200 or 300 percent — but not off enough to explode my point.

My point is this. When researchers at the U.S. Preventive Services Task Force recently contradicted the American Cancer Society’s recommendation that women who have reached the age of 40, even those with no previous history of disease, should get annual mammograms (I’m simplifying their very carefully worded conclusions, which distinguish between film and digital mammograms, and cite other tests), they made a classic mistake.

Not a mistake of research, perhaps, but a mistake of values.

Here is some, just a little, of their language: “The USPTF recommends against routine screening mammography in women aged 40 to 49 years. The decision to start regular, biennial (every two years) screening mammography before the age of 50 years should be an individual one (no kidding!) and take into account patient context, including the patient’s values regarding specific benefits and harms.”

Good golly Miss Molly, that really helps. But they’re not done yet.

“The USPTF concludes that the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination beyond the screening mammography in women 40 years and older (and) recommends against clinicians teaching women how to perform breast self-examination.”

Nosireebob, we don’t want to teach the little women anything.

Oh yeah, they also point out that “current evidence” cannot allow them to draw any conclusions about the benefits of digital mammography or magnetic resonance imaging — instead of film mammography.

And by the way, breast cancer “is the second-leading cause of cancer death among women in the United States.”

Even so, they figure, the damages done by unnecessary biopsies, false-positive tests and “psychological” damage from looking too closely for breast cancer are just not worth it.

I don’t know who these people are who did this study, but I don’t like them.

My wife, my sister-in-law, a number of my friends, and my niece all are women ranging in age from 20 to 50, many of them in their 40s. So is my mother (but only in spirit) — and by the way, these boneheads, if I may refer to them with a word modest and restrained in the extreme, have also written off women over the age of 75.

Most of the finest women we have in this country ARE over the age of 75, and most of the others are growing into that designation sooner or later.

They’re not worth it?

Pragmatism is partly at fault in this study, as far as I can tell from a distance, and by peering through the palmetto scrub that surrounds my house at the larger world. Cold-blooded, rather heartless pragmatism. It just isn’t cost-effective, some say. I heard a female doctor arguing that point on National Public Radio the other day, while a male doctor took the other side.

At least this is a debate in which people drop prejudices about sex. Those two wrestled over percentages — is it 1.5 percent, or is it really 3 percent of women 40 to 49 who will be at increased risk if the new study is adopted as a matter of course — and are those percentages too low to worry about?

Well, not if they’re my family or friends.

And the very term “cost effective” makes me deeply suspicious. Could it be that insurance-company lobbyists have attached themselves to the argument that women shouldn’t be taught how to examine themselves?

I’ve known two women, by the way, who found malignant lumps in their breasts by examining themselves, ultimately saving their own lives.

Are insurance companies tired of getting challenged when they try not to pay for some of the tests women can get? Are they tired of paying, and is that why somebody is willing to write off vast numbers of women?

Forget the percentages that would cause these people to change their minds, for a moment. Instead, look at this percentage: If 3 percent of 110,000 women ranging in age from 20 to 50 get put at higher risk because they’re told not to worry about a lot of testing until they’re 50, then somebody is willing to write off 3,300 women in Lee County.

Sure, many of them have not yet reached the age of 40 (although they’re older than 20, which is old enough to get breast cancer, as countless cases have shown). But how many of those are you willing to write off because it’s not “cost effective” to check?

Maybe 1,000? Maybe 500? Maybe 2,127 or 48 of them?

I’m not willing to write off any, though.

Did I mention I like women?

So my recommendation, minted like a silver dollar from the mighty workshop of male opinionation, is this: Go get that mammogram, ma’am, digital or any other kind, and insist that your doctor teach you how to do a self examination.

And the U.S. Preventative Services Task Force be damned. 