Bedtime Stories and Mammograms

November 23, 2009

When I was very young, my father would read to me before I went to bed. As I began to learn to read, I realized that my father was skipping entire sentences or even pages of stories – presumably so they would end sooner and I would get to bed. When I started calling him on it (“Hey! You didn’t read that paragraph!), the stories started to make a heck of a lot more sense. A similar situation seems to have developed with mammography debate, and our concern at the CT Challenge is that survivors understand what messages they should take from each side of the debate.

Without a doubt, a detailed screening plan is a central piece of the survivorship paradigm. While the recent debate over mammography seems to be largely focused on preventing primary incident breast cancers, my survivorship-tuned ears have perked up. Frankly, I am concerned about how survivors might interpret the complicated messages. What will survivors’ “take home” messages be?

After hearing, reading, and seeing countless statements from qualified, unqualified, experienced, and inexperienced pundits on the U.S. Preventive Services Task Force (USPSTF) statement, I have begun to wonder how many individuals who have publicly commented on the new recommendations have actually read the text of the new USPSTF statement because the most important sentence (for survivors’ ears) in the statement is getting lost in the shuffle. I thought it would be useful to quote directly from the portion Task Force’s recommendation statements that are attracting so much attention. I have bolded the sentence that has been ignored.

(1) The USPSTF recommends against routine screening mammography in women aged 40 to 49 years. The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take into account patient context, including the patient’s values regarding specific benefits and harms.

(2) The USPSTF recommends biennial screening mammography for women between the ages of 50

and 74 years.

That forgotten sentence is of the utmost importance to cancer survivors. By explicitly stating that decision to start screening before the age of 50 should be an individual decision and that decision should take into account the individual’s risk profile and personal values regarding treatment, the Task Force has said that mammography screening plans should be customized for each woman. Survivors, as a population, have a drastically different risk profile than the general population, so it follows that survivors and their care team should develop a screening plan that speaks to the markedly increased risk. No matter what you think is the right decision for “normal” women at any age, survivors should be following unique screening plans developed by their physicians.

As we all know, survivorship advocates have spent countless amounts of energy lauding the benefits of early detection through screenings after a primary cancer diagnosis and treatment, and we simply won’t stand for any confusion of that message. But it is also important that not malign the experts who developed the new recommendations. The Task Force is trying to find ways to reduce the unfortunate pain and suffering that can be caused by false positives and unnecessary treatments. By including specific language about the unique nature of each individual’s screening plan, the Task Force spoke directly to populations with known increased risk and suggested that persons in those populations must develop appropriate action plans in consultation with their doctors. And it is important to remember that the Task Force is only trying to reduce unnecessary pain and suffering; it is comprised of individuals who have spent lifetimes fighting cancer. The very last thing these dedicated people want to see is more pain and suffering at the hands of cancer.

Gina Kolata, who has been covering this story for the New York Times, wrote a nice article in Sunday’s paper detailing the history of the report and how/ why it was generated. You can find the article by clicking here 

Bottom line, the CT Challenge is firm in its stance that survivors should develop customized screening plans in consultation with their physicians. If you are a caregiver, medical professional, or friend or family to a survivor, the CT Challenge asks that you stress the importance of a detailed and customized screening plan.

Christian McEvoy

Director of Survivorship Information

christian@ctchallenge.org

http://www.facebook.com/ctchallenge

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