Monday, November 23, 2009

The Screening Debate

There's been a lot of coverage in the news this past week about recently issued guidelines, by various organizational bodies, pertaining to recommended screenings for women for both breast and cervical cancer. On the breast cancer front, mammogram, as a routine test, is only officially being recommended for women over 50, and for cervical cancer, Pap tests are only being recommended for women over 21 and only once every two years.

After having the "early detection saves lives" messages rammed down our throats for the last 20-odd years, predictably there's now much consternation and brouhaha over these changes. Many of my friends have been asking what I think about this latest set of developments in the the World of Cancer.

So here's my two-cents for what it's worth.

If you've been doing your reading on the subject of breast cancer screening, you would know that these recommendations aren't new. In fact, the debate on this issue goes back at least as far back as the early 1970's. (See recent New York Times article, New York Times Op-Ed column, and Breast Cancer Action press release). The boffins have long known, that STATISTICALLY speaking, early detection and so-called breast cancer awareness, doesn't actually significantly alter mortality rates or outcomes at least as far as breast cancer is concerned.

All it's really meant for many of the breast cancer-stricken population is that they are simply in treatment for longer which may or may not be helpful. The reality is that for many women, breast cancer is still an aggressive disease for which there is still no cure. The thinking has been that the earlier your cancer is detected, the better the chance that you get to live a little longer, and of course the drug companies still get their annuity. On the flip-side, because of the over-success of the "early awareness" campaigns by the Pink Ribbon brigade, some detected cancers are being unnecessarily treated and/or operated on when in reality so they are so low-grade and slow-growing that they would have been better just left alone.

Statistically-speaking, the number of deaths prevented in screening women under-50 comes out to something like 1 in 1900 (a statistic apparently deemed uneconomic and insignificant by the boffins). Well I guess that's reasonable so long as you're not the 1 woman out of 190o, right ?

So this is all well and good, and I don't necessarily disagree with the new recommendations, but the bottom line is this. Both the old and new guidelines failed me, and will continue to fail those women who fall outside the statistical norms. Let's not get caught up in statistics when it comes to our own bodies. Let's have policies and a health system that encourages us to be our own advocates. Let people make up their own minds, in consultation with the medical professionals, as to whether they want the stress and other risk factors associated with cancer screenings.

If you think something is wrong, find your voice. Be heard. You might just save your own life.

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