It's about time the medical profession began taking seriously the costs as well as the debatable benefits of annual mammograms for women over 40 (among other routine screening procedures). If the controversial new set of guidelines constitutes rationing, it may be one form of rationing that's overdue; the challenge is for women who consider "clean" mammograms clean bills of health to recognize that their value is limited, partly by the ability of doctors to interpret them.
I've been a little lax about obeying the annual mammogram mandate for some years, since reluctantly submitting to a biopsy because of an anomaly in a hard to read film. "It doesn't look evil," an oncologist assured me, and nothing that looked evil was revealed subsequently by two ultra sounds and an MRI. Against my instincts (and the judgment of one radiologist who advised a series of follow-up mammograms), I was eventually persuaded to undergo a needle biopsy -- an unpleasant procedure that entailed an overnight hospital stay (of which I have no memory, thanks to some wonderful drugs). "In Europe, they wouldn't operate; their protocols are different," the surgeon acknowledged, when I discussed my doubts about our protocols with him.
This sorry experience was, however, an education in medical decision making: the clinicians advising me (a radiologist, oncologist, and internist) were compassionate, generous with their time, focused on my welfare, and honest about what they didn't know. But an additional radiologist consulted for a second opinion insisted that he could enable a meaningful biopsy, and his insistence inevitably drove the process. My strong belief that he was mainly invested in proving an ability to locate cancers that others couldn't, was no match for the advice of other cautious, trustworthy doctors disinclined to dismiss the claims of a respected radiologist. But they weren't patients, exposed to the boundless egoism exhibited by him and his hospital superior: "Let's hope we're right," the department head said, taking my hand and feigning concern, after I agreed to the biopsy. "Let's hope you're wrong and I don't have cancer," I replied.
The biopsy was negative, but it didn't mean that I didn't have cancer: it meant that tissue extracted in what may have been a meaningless operation was benign -- which is not to say I wasn't relieved. But along with relief, I gained an understanding that yearly screenings and even biopsies can offer no guarantees of being cancer-free. So I wonder how many women will welcome the new recommendations for fewer mammograms, perhaps greeting them with a silent "I told you so," and how many will continue the yearly screening regimen, with its false positives and, perhaps, even falser sense of security.
(Photo: Scott Meis Photography/Flickr)
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