Chill Out People! (Mammograms and Pap Smears)

[eema.gray]

I read the release of the new research about mammograms and pap smears like, 30 seconds before the news hit the streets here on Cafemom.  Because I read it BEFORE getting here, I actually read the information and could make some evaluations logically, not based on the hype the news is getting here on CM.  That doesn't make me better; it just means I had the ability to read without bias.

Here's what I got out of the news.

Number One.  This is most important.  This research has been in the making for at least half a decade.  It is pure coincidence that the results are coming out now, during the health care reform debate.  A lot of women are assigning blame on Obama's health care advisors.  I don't like Obama's policies; I didn't vote for him.  But I'm not going to blame him for everything.  Governments don't just stop when one President leaves office and pick up in an entirely different area when the next President comes in.  The new guidelines have NOTHING to do with Obama or his health care proposals!

The corollary to this is:  The new guidelines are not a vast conspiracy to control population in this country.  Really?  I actually saw several comments to this effect earlier today.  Pointing to the above paragraph, this research has been in the works for YEARS and is NOT tied to any government body.  

Number Two.  Also extremely important.  These are guidelines!  They are not rules!  Nobody is forcing YOUR doctor to not write the order for your next mammogram!!  These are suggestions from a group of researchers who, yes, are indirectly tied to the insurance industry.  Now think about this point logically.  Insurance companies make money when people don't need to use their insurance benefits.  While this encourages people to not get preventitive care (stupid and short sighted from an insurance point of view) this also means that doctors who treat conditions early and aggressive that *tend to* go away on their own or are otherwise benign in the first place cost insurance companies money.  Insurance companies don't want to pay money.  So if they can encourage doctors to not treat every lump like stage 4 breast cancer, the company saves money.  It's good business sense, from a certain point of view.

Number Three.  The new guidelines are for LOW RISK women ONLY!  If you have any sort of personal or family history or if you engage in risky behavior (or have in the past, most cervical cancer is caused by STD's), then these new guidelines are NOT for you!  Women in any sort of increased risk category should and are strongly urged to get yearly screenings.

Number Four.  Many times, an abnormal pap is *just* an abnormal pap.  They come up weird all the time for various benign reasons:  You had sex an hour before you went in for your annual.  You finished your period two days ago.  You recently finished treatment for an infection.  Etc.  There are many reasons why your cervical cells look slightly abnormal.  Also, the labs that process paps are ridiculously overworked.  Techs often give each slide only a two or three second look before writing down normal or abnormal.  When techs go that fast, it's very easy to make mistakes.    

Women who do not engage in risky sexual behavior, women who are past the age of reproduction, women who are low risk AND have had normal paps for years, women who have been with a single partner for many years - all these women are at a much lower risk of developing cervical cancer.  It makes no sense to treat them the same way we treat high risk women.  We are NOT preventing cervical cancer by treating every women as if she is at increased risk of developing cervical cancer!  In fact, we are spreading valuable resources too thin if we treat all women the same way (at the bottom of the chain, lab techs can take more time with each slide if they have fewer to process).  It makes more sense to focus care on the women who need high risk care and take reasonable preventive measures with everyone else.  You save money, your insurance company or the government if you're on medicaid or state insurance saves money.  If you're LOW RISK, what's wrong with that?

Now, apply the same to breast cancer.  You're young, let's say late 20's.  You have no family history of breast cancer.  Maybe you've nursed one or more children (breast cancers are sometimes fueled by estrogen which you get more of if you don't nurse).  You don't take hormonal birth control (again the estrogen exposure).  You know what's normal and not normal in your breast tissue.  Then your doctor finds a lump during your annual exam.  Here you've got a couple choices.  You walk out knowing where the questionable bump is and practice watchful waiting for a month or two.  You know odds are the lump will probably disappear in the next few weeks.  Or you walk out with an appointment for a biopsy in a few weeks time.  Again, remember that you're LOW RISK.  Either the biopsy finds nothing because the lump disappeared on its own or else it comes up benign.  Exactly why did you (or your insurance) just pay for an extra visit, the cost of a biopsy, the cost of the lab looking at the biopsy, and the 3rd visit back to the office so your doctor could tell you the results?  That's probably another thousand bucks or more just to find out nothing's wrong, vs. spending nothing and waiting to see if the lump goes away.  If it doesn't, then you clearly need to pursue further action.  But most of the time lumps go away on their own.  If you're LOW RISK, there's no harm in waiting a few weeks to see what happens.

The mammogram technology available in most of the country hasn't been upgraded in a decade or more.  Yes, state of the art equipment is well shielded and virtually risk free but that's not what every woman in this country gets to use.  If she lives away from a major city, if she pays out of pocket, goes to a public health clinic, has little or no insurance, the higher the chances that she'll be getting mammograms on much older equipment.  That has higher exposure to radiation.  Which ups her chances of getting cancer in the future, ironically enough.  Besides that, the mammogram technology most women have access to frequently can't detect lumps until a woman herself has already been able to feel them.  If I can already feel the lump, what is a mammogram going to tell me?  It can't diagnose cancer.  It can only tell me something's there.  So look at it this way:  By telling women they must get a baseline at 35 and yearly scans at age 40, what we're really saying is we don't  trust you.  We can't bring ourselves to believe you check yourself, know your body, and know that there's a lump that hasn't gone away since you first found it six months ago.  You have to get this scan because we don't trust you.  Hmm, yes, that's comforting.

[RissaBusch]

Nov. 20, 2009 at 3:21 PM

I'm enjoying my panic party though.....

[purpleducky]

Nov. 20, 2009 at 6:18 PM

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