By Kathleen Parker
Wednesday, November 18, 2009
That's not a word one hears much these days, but calm is what some are urging in the wake of a new federal report on breast cancer screening.
Released Monday, the paper has caused a stir with its recommendation that women in their 40s don't need annual mammograms and that self-exams no longer should be part of a doctor's instructions to female patients. Instead, the report suggests, women ages 40 to 49 who are not in a high-risk group should wait until 50 to begin mammograms and then have them every other year.
This is surprising news to women who, for the past 30 years or so, have been urged to spend part of their shower reviewing their breast tissue and have submitted annually to the vise otherwise known as a mammogram.
Is this yet another one of those eggs-are-good-for-you-eggs-are-bad-for-you routines? Which is it, please?
Meanwhile, the timing of publication, in the midst of a health-care reform debate about reducing medical costs, has eyebrows raised. Under the proposed reform, the federal recommendations are to be used for setting standards for insurance coverage. Could the research be aimed at cutting costs at the expense of women's health?
While some cancer groups, including the American Cancer Society, have objected strenuously to the panel's recommendations, Susan G. Komen for the Cure, the worldwide advocacy organization, is aiming for a more measured -- strategic -- tone. It would be a mistake to overreact, says Eric Winer, Harvard oncologist and chief scientific adviser to the Komen group.
Instead, Nancy Brinker, Komen founder and the woman responsible for "pinking" the world, views the report as yet another opportunity for activism. If current screening is imperfect, then why not make it better?
You don't get pink ribbons on everything from running shoes to electric mixers, after all, by going negative. Thus, Brinker, who recently bathed Egypt's pyramids in pink lights during one of Komen's 130 annual runs, sees the federal report as a good thing -- a "clarion call" for funders, researchers and government to deliver a lower-cost, more-effective screening tool.
"We need 'tomorrow technology' and we need people to invest in it," she says.
The Komen organization, which funds 1,900 education, awareness and screening programs around the world, isn't changing its own recommendations for annual mammograms and self-exams for women 40 and older. It may not be a perfect protocol, but Komen's goal is more access to screening, not less. Still, both Brinker and Winer acknowledge that there's more agreement than disagreement with the findings of the report, issued by the U.S. Preventive Services Task Force. The problem is that "we've sought out the areas of controversy rather than the areas of consensus," says Winer.
Areas of agreement include: that mammograms do save lives in both younger and older women; that it is travesty that one-third of women in the world don't have access to screening; and that while imperfect, the mammogram is the best test we have.
Areas of controversy surround the when, whom and how often. As for breast exams, Winer says it's pretty widely accepted that teaching women to examine themselves is not more effective in detecting breast cancer than not teaching them. The fact that many women discover their own cancer probably means that women are aware of their own bodies and respond intelligently to changes or abnormalities.
Winer also says that the panel's findings are based on analysis of several large and well-conducted studies and that different conclusions are probably a function of "murky data."
"You can't conclude that they got it wrong," he says.
Nevertheless, breast cancer is an emotional issue. Computer models aren't reassuring if you have breast cancer yourself. Or if someone you loved might have survived with earlier detection.
Brinker understands the personal dimension on a profound level. A survivor of breast cancer, she lost her sister (Susan G. Komen, for whom the foundation is named) to the disease at age 36. Even so, she prefers action to reaction.
These days, Brinker isn't focused only on breast cancer but on all cancers, which she says are decimating populations around the world. During an interview at her apartment, she emphasized the need for better education, noting that cancer is still considered contagious in some countries and that sufferers are treated as lepers.
If Brinker has her way, the debate relaunched Monday will lead to improved technology so crucial to detection. If history is any guide, we may soon expect to see new pink screening gizmos that are cheap, portable and accurate.
And the world will be calmer. And we shall all eat eggs.