11.17.09
Breast Cancer.
Did you catch NPR this morning? It seems "new studies" show that doctors are wasting money and performing unnecessary procedures on young women in the attempt to diagnose breast cancers, some of which will never really cause any problem! And the false alarms are a terrible price for the woman to pay if the extra tests or biopsy mammograms lead to turns out not to be cancer after all. So, these "experts" now suggest: Stop doing breast self examinations. Stop doing screening mammograms in women until 50, and then, screen every 2 years. Think of the money we will save. Go ahead, put off getting that next mammogram.
The "experts" quoted in this latest torture of the facts are in the minority. The American Cancer Society, the American College of Obstetrics and Gynecology, and the American College of Radiology still recommend screening mammograms at age 40.
Here's why: The "sojourn time" in medical lingo is the time it takes from the point a new breast cancer is first detectable by screening mammography until the time the cancer is clinically apparent, either as an obvious, palpable mass or symptoms arising from distant spread of the cancer. It represents, quite literally, the window of opportunity whereby screening mammograms have a chance to find a pre- clinical breast cancer, at an earlier stage in the cancer's life, and at a stage where the prognosis for breast conservation and a complete cure is much better.
It is medically proven that screening mammograms, by detecting cancers earlier, saves lives. There is and can be no debate on that point. The debate is over the "cost" of doing so.
The average sojourn time of breast cancers in women age 40 is 1.4 years. In women over 50, it is almost 4 years. Breast cancers tend to be more aggressive in younger women (hormone effect) and in black women (genetics). And in general, the faster growing, more aggressive cancers, at any age, are the "killer cancers" that contribute significantly to the overall mortality of breast cancer.
If the window of opportunity on fast growing cancers is less than the new proposed screening interval of 2 years (if at all, before age 50), then mammogram screening will continue to find the slower grower cancers, but begin to miss a large proportion of aggressive cancers in younger women--the killer cancers. The sad result is that the mortality rate, especially in young women, in the prime of their lives, the ones with families and small children, begin to die at a higher rate.You may or may not remember the debates some 20 years ago about mammograms not affecting "survival outcomes" in women under 40. DUH! If you don't screen at an appropriate interval, then this exactly right and easily predictable-- younger women with breast cancer will die at a higher rate, as will older women with more aggressive , faster growing breast cancers.
Add this fact: the most common lawsuit in all of medicine is the missed or delayed diagnosis of breast cancer. So doctors who perform screening mammograms already have a target on their back. It is sadly easy to roll a young woman in a wheelchair into the courtroom, no hair, dying of breast cancer, husband and kids at her side, and have an "expert" testify that the doctors should have made the life- saving diagnosis earlier. There is no more sympathetic figure for any jury.
But this is just the beginning, a preview if you will, of what your government considers the best health care for everyone. Tie one hand behind the doctor's back, pay them less, and do nothing to lessen legal liability through any meaningful tort reform- sound policy? I think not.
Please share this with your wives, mothers and loved ones. Please don't take a politician's word about what is best for your health. Your very life may be at stake.
Tommy E. Cupples, MD
Womens' Care at ImageCare
Columbia, SC
