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November 17, 2009 - New York Times Article about the Task Force Findings on Breast Cancer Screening The release of the most recent study by the U.S. Preventative Services Task Force (USPSTF) regarding screening for breast cancer made me sit back, scratch my head and, like many others, wonder “Why?” Right away I was inundated with emails and calls from friends, colleagues, and the media asking for my take on this shocking new information. This is the first time I’ve been looked to as a “breast cancer advocate” and it made me realize that I have a responsibility to respond. Not only on a personal level, but also as an advocate with a duty to help others make sense of these confusing messages. For many women, like myself, it’s hard to look at these findings in any objective sort of way because of a personal affiliation or experience with the disease that may differ from the conclusions presented in the research. However, it’s important to do so in order to truly absorb the information and the possible value it might have. And so with that in mind, I hope to present an objective take on this study as well as identify some conclusions that I believe are critical for proactively managing breast health. The study presented many concerning statistics as support for two major shifts in thinking related to breast cancer screening primarily in younger women. The first major shift: Suggestion to change the age of screening mammograms from age 40 to age 50 and reduce frequency from every year to every other year. In light of the fact that breast cancer survival rates have increased dramatically over the past 10 years, this seems counterintuitive. While personally I may see this as a huge step backwards for the breast cancer community, I was a bit shocked when I realized that my own diagnosis actually concurs with the rationale behind this new suggestion. As it turns out, most women diagnosed at a young age with breast cancer first present with a symptom (breast lump or other change) and then subsequently receive a diagnostic mammogram to aid in the diagnosis. It’s not the mammogram that initially discovers the cancer; it’s the identification of a symptom that leads to a mammogram and the subsequent cancer diagnosis. So let’s assume that line of thinking is factually correct. That brings me to the second major shift in thinking presented in this study: Suggestion that “breast self-exams” should not be taught because they do not reduce breast cancer mortality. It is important to note that the definition “breast self-exam” means something very specific. This term refers to the step-by-step formal process used to examine your breasts. This process often appears in detail on shower cards and includes suggestions about when the exam should be given or what pattern should be used when moving your fingers around your breast. This formal process is what they are saying is ineffective. While the medical community has been shying away from “breast self-exams” in recent years (this study was not the first to present this shift in thinking), it has begun to promote what is called “breast awareness”, which refers to simply ‘knowing your body’. Research has in fact shown that simply “feeling your boobies” or being “breast aware” is just as or more effective than the formal procedure of “breast self-exams.” Most often, a woman who finds her own lump discovers it through the course of daily routine and NOT by the formal BSE process. Again, this finding actually concurs with my own diagnosis. I was not doing a “breast self-exam” when I found my lump. While my own breast cancer diagnosis may be evidence that supports the findings presented in this report, I still take issue with the suggestions it presents. The danger with studies like this one, particularly outside of the medical community, is that the most common takeaway is one of passivity - “you don’t need to feel your breasts and breast cancer is only an issue for older women” - when in fact that is far from what is being said. The nuance of the terms and statistics in these studies, while significant and meaningful to the medical community, create confusion among the general population where the same nuance is drastically misunderstood. I fear that the inevitable result is a large group of women, who already don’t believe they are at risk for breast cancer, who now may feel they have been given permission to “put their head in the sand”. For those of us who dedicate our lives to promoting proactive breast health, it makes the hill we climb that much steeper. Leigh Hurst, Founder Feel Your Boobies Foundation |
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