Saying ‘No Thanks’ to Cancer Screening

English: Mammography in process: Shown is a dr...
English: Mammography in process: Shown is a drawing of a female having a mammogram. A mammogram is a picture of the breast that is made by using low-dose x-rays. (Photo credit: Wikipedia)

Earlier this week I went to my primary care physician for a well-woman check-up. Truth be told, I went back because she wouldn’t refill my medications without a follow-up visit. In the past two years I’ve had only nurse visits for the annual flu shots and TB tests I need for work. I’ve felt—and am—healthy.

I like my doctor. She’s a family medicine doctor who specializes in women’s health, and she ‘treats me like an informed adult’ (her words) when I politely refuse her recommended cancer screening tests, such as mammograms. Except for my age, I am in a low-risk category for most cancers. I know first-hand the cascade of negative, iatrogenic effects that cancer and other medical screening can precipitate. I also know first-hand that many doctors and other health care providers (including nurses) can take personal offense to such ‘non-compliant’ patients as myself. I’ve been scolded like a recalcitrant child and even had an angry radiologist tell me I was being stupid for declining a mammogram. I’m fortunate that I live in a large metropolitan area, have sufficient health insurance, as well as good health literacy, that I can fire these health care providers and find better ones.

But even my current ‘good doctor’ smiled at me ruefully as she said she had to keep encouraging me to have the recommended screening tests done—as she was checking off boxes on my electronic medical record. I realized I was probably reducing her monetary incentives for quality of care measures, and failing to contribute to paying off the expensive state-of-the-art mammography machines that her particular health system owns.

The day after my doctor’s visit I read the provocative NYT Op-Ed essay “Cancer Survivor or Victim of Overdiagnosis?” written by physician and Dartmouth health services researcher H. Gilbert Welch. He refers to recent results of research published in the NEJMEffects of Three Decades of Screening Mammography on Breast-Cancer Incidence,” a paper he co-authored with Archie Bleyer, MD (11-22-12). They looked at U.S. population-based data from 1976-2008 on breast cancer screening, and the incidence of both early and late-stage breast cancer. They estimated that breast cancer was overdiagnosed (tumors detected on screening that would never progress to clinically-relevant symptoms/ ‘real cancer’) in 1.3 million women in the past thirty years. The incidence of overdiagnosis is likely to have increased exponentially in the last decade with the use of more sensitive digital mammography screening. The researchers conclude that screening mammography has little to no impact on breast cancer mortality, and indeed, is doing more harm than good as a public health measure.

They do acknowledge that breast cancer mortality has fallen substantially in the U.S. and Europe over the past thirty years (and especially so for women diagnosed before age 40 when they wouldn’t have had mammograms), but that it is due to improved treatments and not to breast cancer screening.

In his Op-Ed essay, Dr. Welch points out a health literacy deficit (or a calculated ’misrepresentation/pinking of the truth’ I wonder?) in a recent Komen Foundation campaign “Early Detection Saves Lives.” Survival rates always go up with early detection. If you tell everyone they have cancer, survival will be bound to skyrocket.

I read an interview with Dr. Welch where he urges healthy skepticism toward standard medical practice—like those listed in the check-boxes at my doctor’s office. Our tests and screenings have become so sensitive that we can find abnormalities in just about everyone. That can start a cascade of harmful events (including the stress from the ‘diagnosis’ and uncertainty), when most of those abnormalities won’t end up causing disability or death. He concludes with “Health is much more than not being able to find something wrong.”

The Race from the Pink

English: These are some items given away to pr...
Image via Wikipedia

The Susan G. Komen for the Cure foundation vs. Planned Parenthood political drama this week was fascinating to follow. This, of course, was the news that Komen was withdrawing all grant funding to Planned Parenthood for breast cancer screenings for low-income women. After a groundswell of public outrage over their decision, Komen’s founder and CEO, Nancy G. Brinker made a public announcement upholding their decision and trying to assure people that it wasn’t politically motivated—the subtext that it had nothing to do with the fact that Planned Parenthood services include abortion. Then when her explanation only made the backlash worse, Brinker announced they would reverse their decision and fund Planned Parenthood at least for this year. This drama all happened over the course of four days.

When listening to people’s conversations about this unfolding drama—especially around my nursing-type friends and colleagues—I was surprised at how many of them were surprised that the Komen foundation would do such a thing. The sacred hot pink halo hovering over the Komen foundation has blinded most nurses—as it has blinded most of the general public. It has never been PC to critique the Komen foundation’s stated “race for the cure” of breast cancer. It was also interesting to discover how many people didn’t realize that Nancy G. Brinker is far right leaning politically. She has long been a major Republican donor, and was named Ambassador to Hungary and then Chief of Protocol (e.g.: official ‘party planner’ for visiting dignitaries to the White House) under Bush.

In 2010 the Komen for the Cure foundation pulled in $311,855,544. The top administrators make over $500,000 per year. And although many Race for the Cure pink t-shirt wearing participants think that most of the money they are raising goes to fund breast cancer research, only ~20% goes to research. At least a million dollars a year seem to be spent on legal fees for the Komen foundation to sue anyone using ‘for the cure’ or anything approximating a pink ribbon in their marketing. Breast cancer has become big business—even for the supposed non-profit Komen foundation. Barbara Ehrenreich (of Nickeled and Dimed fame) uses the term “Cancer Industrial Complex” when discussing everything that profits from cancer—and especially from breast cancer. Writing in November 2001 in Harper’s Magazine (“Welcome to Cancerland: A Mammography Leads to a Cult of Pink Kitsch”) Ehrenreich reports that the breast cancer industry is estimated to be a $12-16 billion dollar a year business in the US, between all the breast cancer centers, radiation centers, mammograms, surgeries and drugs (doesn’t include breast cancer research spending).

And then, of course, there are the dismal statistics pointing to the fact that all the increased breast cancer research, increased focus on mammograms, early detection and treatment, really haven’t changed the death rate from breast cancer.  On the Susan G. Komen website—in amongst the flashing hot pink merchandise to buy—is Nancy G. Brinker’s declaration that the Komen foundation has “changed the world.” The world is pinker perhaps.