Waiting Until 50 for Mammograms

I have long been uneasy about the guidelines for mammography. My doctor didn't begin hounding me until after I'd finished breastfeeding my daughter. I was nearly 43 and not considered high risk by any measure, but the guidelines called for screening to begin at forty, and I was nearly two and change years past that date. Recently studies have pointed out what has been long known but little discussed - at least with patients - that mammograms before forty don't improve mortality rates where breast cancer is concerned. Even more startlingly, it was possible that women were being treated for cancers that posed no threats to their lives and that others were being treated for things that turned out to not be cancer at all.

I know that everyone has a story of a loved one, friend or friend of a friend who discovered a lump during a mammogram that was removed and is now a cancer survivor. But has anyone ever stopped to consider that perhaps some of these cancer survivors were never in danger of life threatening illnesses in the first place? Or that the treatments they underwent have placed that at greater risk of medical problems in the future than they would have faced otherwise?

It's heresy to suggest in our pink ribbon culture that perhaps the aggressive stance that medicine has taken with the female breast in terms of screening has been anything less than necessary and productive, but more and more evidence is coming to light to suggest that the aggressive breast cancers that are killing women are not usually found through screening and that those lumps and abnormalities being discovered are over-treated. The trouble is that though doctors are very good at finding things, the science that would allow them to decide what is deadly and what isn't doesn't exist yet.

And it's not just mammography. Colonoscopies for the elderly have been called into question as well as MRI's to screen for lung cancers. Truthfully, we have very few proven screening methods for cancer. PSA's have not delivered in terms of prostrate cancer, and men whose doctors adopt a wait and watch attitude have better outcomes in terms of quality of life. The pap test is one of the few cancer screening tests that has actually reduced mortality rates and ironically, it is something that might not make the final cut when the Senate is finished tweaking the health care bill.

Understandably there will be reluctance to let go of past advice and embrace the new guidelines despite the fact that 50 or even post-menopause is the standard for mammograms according to guidelines set by the WHO. Americans are a fearful lot with a low threshold for lack of control. We like to believe that there is a prevention, if not an actual cure, for everything. We are a death denying culture and the truth is that some of us are going to die from cancer in spite of our belief that medicine is the cure for everything, and when it comes to cancer, the truth is that some of us will die and some of us won't and medicine really can't predict or explain why that is.

Eventually my doctor gave up although she dutifully wrote up a script for me every year. I explained my position, based on my research, and she accepted that she wasn't going to sway me with anecdotal horror stories and ultimately respected my decision to be an informed non-consumer. My new doctor isn't quite ready to give up, but at our next appointment I will have the new guidelines behind me.

The discussion being waged over the new mammogram guidelines is a good one. Women are now thinking and reading and making decisions based on individual needs rather than the one size fits all group-think that they have been conditioned to accept.

This is an original post for 50 Something Moms by Ann Bibby of Care2 and anniegirl1138.