For almost two decades, breast cancer has been a very visible public health issue. Women over the age of 40 (or sometimes 50) are pressured by doctors, health advocacy organizations, friends, family and pop culture to submit to a yearly mammogram. It could save your life, we’ve been told.
We’re told not to worry about the discomfort or pain, the strangeness of having your boob squished like a pancake in a giant X-ray machine, the possibility of false positives. We’ve been reassured that the level of radiation to which we are exposed is minimal.
This insistence on yearly screening has seemed problematic to me for many years, in part because of my own observations working in the healthcare industry.
For a year, I had a job at the Family Medicine clinic at the University of Washington. My job was to check in patients, call in referrals, file their paperwork and be the friendly face they saw at the front desk.
One of the things I noticed was the number of scans that women were being asked to undertake. Full body bone density scans. Mammograms. Abdominal x-rays. Pap tests. The doctors offered (and sometimes directed) women toward an onslaught of screening tests. On the other hand, male patients were rarely sent for routine screening exams.
It doesn’t take a genius to guess that this might be an issue. After all, we have no reason to think that researchers or clinicians take women’s health more seriously than men’s health. Yet there is a history of putting women’s bodies under the microscope, of seeing them as breeding grounds for disease, of poking and prodding and monitoring.
This annoyance and irritation at the way female patients were treated by the medical field t propelled me into graduate school. Why was there such an interest in promoting mammography? What were women really getting out of it? What did the pink ribbon really mean?Do mammograms really save lives?
Turns out, the answer is no.
A new observational study published in the New England Journal of Medicine oncluded that mammograms don’t work. In his beautifully argued op-ed in the NYT yesterday, David Newman points out that although observational studies are not the gold standard, in this case the approach was strategic. The study confirms the conclusions drawn from a series of clinical trials: Mammograms might increase diagnoses and may increase treatment, but they don’t save lives. You’re just as likely to die from a breast cancer detected from a mammogram as you are from breast cancer you detect yourself.
So why do doctors and health advocates persist in pushing women to get the test?
Newman puts in this way:
[T]he trial results threatened a mammogram economy, a marketplace sustained by invasive therapies to vanquish microscopic clumps of questionable threat, and by an endless parade of procedures and pictures to investigate the falsely positive results that more than half of women endure. And inexplicably, since the publication of these trial results challenging the value of screening mammograms, hundreds of millions of public dollars have been dedicated to ensuring mammogram access, and the test has become a war cry for cancer advocacy. Why? Because experience deludes: radiologists diagnose, surgeons cut, pathologists examine, oncologists treat, and women survive.
While Newman doesn’t bring in a feminist or gendered analysis of this issue, it’s sitting right there, the pink elephant in the room. Just like the continued marketing of hormone replacement therapy, or the lack of non-invasive methods to detect cervical cancer, mammography has been accepted practice for so long because culturally, it’s perfectly fine to expect women to submit themselves to poking and prodding and examination.
What do you think? Have you had a mammogram? Will you get one (or stop getting one) after hearing about this study?