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?
Reproduction used be so straightforward. People did it the um, old-fashioned way, and mostly they didn’t plan. Today, almost forty percent pregnancies in the US are unplanned, but for many women, planning to get pregnant is a very involved undertaking.
The data shows that in this country, 15 percent of women with their first child are elderly primigravidas, that is, they are older than 34.
An entire industry that has now been built up around this fact. Your eggs are old! You waited too long! How will you reproduce?
Capitalism and innovation is here to help. Go to any CVS or Rite Aid in the country, and you’ll be offered a wide selection of ovulation prediction kits ($35 for 2), a host of products aimed at boosting your fertility, and even home fertility tests .
An ongoing study at UNC Chapel Hill found that these tests are quite inaccurate.
One-quarter of the women would have been deemed infertile based on their FSH levels, but in fact they did not have more difficulty getting pregnant than other women in the study, the researchers reported.
The study is still recruiting, and will be until 2015. It’s refreshing to read about scientific research that is actually trying to help women achieve their fertility goals instead of coming up with more findings about how fertility declines, and a host of possible factors that might be associated with infertility.
And just a side note, here’s the principal investigator of the study:
The group gave tablet computers to poor children in Ethiopia with apparently stellar results. In this particular region of Ethiopia, the children were particularly impoverished, did not read, and were not going to school. “We went in, gave them the tablets and walked away,” said Matt Keller, the Vice President of the Global Advocacy.
These kids are learning faster than they would be learning in school. When you give a child that tablet and all the other children in the community have the tablets, the children learn form each other, they teach each other, the dynamic is so intense that I have to say yes, it’s better than a classroom.
The story jumped out at me because as a parent, I am repeatedly warned against exposing my child to too much “screen time.” I just got an email from my child’s preschool teacher that cautioned television watching before bedtime, and in my social circles, dropping off a bunch of iPads to kids and then just letting them sit there and play with them all day would be seen as tantamount to child abuse.
What happens when toddlers zone out with an iPad? asks Ben Worthen in the Wall Street Journal, and concludes that the things aren’t good for his child because he goes into a sort of trance and it becomes a daily battle to get the boy to put the thing down and go
the fuck to sleep to bed.
Apparently they can be a great tool for kids with autism, cerebral palsy and various other disabilities. But table comptuers can also make it more difficult to sleep, and there is persistent concern about their effect on children’s brain development, attention span and learning ability.
In public health, we talk about providing appropriate technologies for the situation. Is dropping off a bunch of tablet computers to poor children an appropriate technology? Does it make sense in the context that they live?
Do we have different standards for the health of our own children and the health of other people’s children, poor children? Would we want this for our own children.
Paul Farmer talks about creating a preferential option for the poor, arguing that it is the role of the non-profit and charity world to charge themselves with offering the poor people of the world the same –if not better — medical care as wealthy patients in developed countries.
Idealistic? Yes. But it’s something that I always think about when new programs are rolled out or when a researchers is talking about their groundbreaking work in a poor country.
What do you think?
Have you heard about One Laptop per Child ?Do you worry about whether too much “screen time” affects the health of your own child(ren)? Are there other programs that you know about that employ new technologies innovative ways? Tell me, I want to know!
For the past two years, I’ve been trying to earn a living as a freelance writer and editor. Sometimes it works, sometimes I run into lean times. Right now it’s lean. So this week, in an attempt to keep the lights on, I’ve stepped out of my house and into a real office. I’m working a temp job for the next three weeks, so my days are full of commuting, filing and data entry, with not much time for blogging.
The job’s not so bad – it’s a little boring, but the computer terminal I’m sitting at faces a wall of windows, and when I look up from the computer it’s like I’m sitting in a forest of glorious fall foliage. The weather is gorgeous, and there’s a little picnic table outside where I can eat my lunch…and think about women, work, and occupational health.
At this particular job, the feminization of office work is as clear as day. All the temps and all the supervisors are women. As far as I can tell, most of what the permanent folks do is file and do data entry.
It makes me wonder, do women have a higher rate of carpal tunnel syndrome? What kinds of occupational health hazards are common for women who work in offices? What kinds of health problems are caused by sitting in front of a computer eight hours a day? How much radiation does a computer emit? Is it dangerous? What is the data?
This office is miles away from any real restaurant. There’s not even a vending machine. If you forget your lunch, you can drive to Bojangles or Arby’s if you drive really fast and eat your lunch in the car. There are, however, copious bowls full of Halloween candy on the filing cabinets. When I studied abroad in Iceland, one of the most incredible things about their work life was that all office buildings have beautiful cafeterias, and everyone eats together. In the US it seems like working in an office is set up to make you have bad nutrition.
I’m lucky (for now) that this is just a temporary gig, which means I actually enjoy it. It’s a whole lot easier than writing and a whole lot easier than chasing a three-year-old around, but I wouldn’t want to do it every day.
What about you? Do you work in an office? What kinds of things do you find are good – and bad—for your health at work? What do you think are some occupational health issues that women face more commonly than men? What about other jobs? Seems like service industry jobs and healthcare industry jobs probably come with their own set of occupational hazards.
What do you think?
It’s been another great week!
I started a new series, profiling women in health. If you would like to be profiled or have an idea of someone you think I should talk to, please let me know.
I’ve been pitching lots of stories about women’s health to a variety of news outlets and blogs, and will hopefully have some good news to share soon.
And a confession – I didn’t watch the veep debate. I listened to part of it on the radio, but missed the visual antics. Oh well, I’ll be watching on Tuesday as the presidential candidates face off for the last time.
Here’s what caught my eye in health news this week:
- Injections in the spine never seems like a great idea, but even worse when the medication is full of fungus. Some things definitely need lots of regulatory oversight!
- In a valiant effort to take the mind-body connection seriously, two studies look at the role stress when it comes to breast cancer and maternal well being.
- Floridians are voting on whether ban state funding for abortion, in addition to the existing ban on federal funding for abortion, put in place by the Hyde Amendment. Will they also be voting on whether to increasing state funding for birth control?
- Scientists have come to a consensus that formaldehyde causes cancer. So why are lobbyists trying to keep this information under wraps?
- No one wants to go on a job interview when they’re pregnant, and lots of women are nervous to tell their employers that they are pregnant even when they already have the job. Been there.
- The UK takes a big step, and makes treatment available for HIV positive patients who need them, regardless of immigration status. Public health in action.
- 3D mammograms: twice the radiation, three times the fun?
Thanks for reading! Have a great fall weekend, and see you on Monday.
Oh, occasionally a women’s health blog/fair/publication/clinic will include information about heart disease, or nutrition, or even chronic illness. For the novelty factor, it might include something about HIV. But most of the time the term “women’s health” is about getting knocked up, not getting knocked up, and boobies.
I’m as guilty as the next person when it comes to limiting my scope: I wrote a dissertation on breast cancer, a master’s thesis on breast feeding, and worked for an organization that focused on reproductive health.
Unlike womb health and boob health, mental health isn’t typically classified as a women’s health issue. That’s unfortunate, because mental health could possibly be the most important topic when it comes to women’s health. After all, if you don’t have your (mental) health, nothing else matters.
Whether it’s post-traumatic stress disorder, postpartum depression, bi-polar disorder, depression and anxiety, or even loneliness, mental health is something that is shaped by gender.
According to the World Federation on Mental Health, depression is not only a worldwide crisis that affects 350 million people a year, it is also a highly gendered affliction:
While depression is the leading cause of disability for both males and females, the burden of depression is 50% higher for females than males (WHO,2008). In fact, depression is the leading cause of disease burden for women in both high-income and low- and middle-income countries (WHO, 2008). Research in developing countries suggests that maternal depression may be a risk factor for poor growth in young children (Rahman et al, 2008).
This risk factor could mean that maternal mental health in low-income countries may have a substantial influence on growth during childhood, with the effects of depression affecting not only this generation but also the next.
Treatment is different for women too. We’re more likely to be diagnosed with depression than men, even if we both give the same list of symptoms. And women are more likely to be prescribed mood altering psychotropic drugs.
Furthermore, there are significant health disparities when it comes to women’s mental health, and not just having to do with unipolar depression:
- Women experience twice as much serious mental illness as men
- Women have a life-time prevalence of alcohol dependance that is more than twice as high as that for men
- Postpartum depression and anxiety are common, but poorly diagnosed and treated. That means many (if not most) women suffer through this alone.
- Women and girls are at least twice as likely to have an eating disorder than are men or boys.
What’s the reason for these disparities?
It’s complicated, but the inequalities inherent in patriarchal societies bear some of the responsibility.
Eating disorders emerge because of an unrealistic image of the female body that is presented in the media. Postpartum depression goes untreated, and can lead to further mental health problems. Women experience more poverty, more workplace harrassment, and do more caregiving for family members than do men.
Furthermore, according to the World Health Organization, the high prevalence of sexual violence to which women are exposed and the correspondingly high rate of Post Traumatic Stress Disorder (PTSD) following such violence, means that women are the largest group of people affected by this disorder.
We don’t like to talk about mental illness in this country, and we don’t do a great job of treating it. We throw drugs at it (there’s been a gigantic increase in the number of Americans on anti-depressants, but are we mentally healthy?) We pay lip service to it. But more often than not, we ignore it.
In the US, even if you are lucky enough to have insurance, chances are that it doesn’t offer mental health parity.
For once, the US is not the only country doing a shabby job of providing healthcare. According to the WHO:
Mental, neurological, and substance use disorders are common in all regions of the world, affecting every community and age group across all income countries. While 14% of the global burden of disease is attributed to these disorders, most of the people affected – 75% in many low-income countries – do not have access to the treatment they need.
Reading this onslaught of bad news may not make you feel very mentally healthy, whether or not you’re a woman. But it’s important to share this information as a reminder that mental health is a major health issue for women and that it should be addressed under the umbrella of women’s health.
It’s easy to focus on babies and boobies, but looking at other health issues through a gendered lens may help decrease women’s morbidity and increase quality of life.
What do you think? Do you know any women’s health organizations that are working on this issue? What does the research show about mental health disparities? Are there things that clinicians can do to better protect the mental health of their female patients?
Welcome to October. As you probably know, it’s National Breast Cancer Awareness Month.
That means you’ll be inundated by things like this
Breast cancer has become so hyper-visible that it’s hard to believe we really need any more awareness. So many of the activities related to breast cancer are just an opportunity for corporations to pay lip service to women’s health. National Breast Cancer Awareness Month has become just a tired ritual, when women’s magazines trot out their “Five Things You Need to Know about Breast Cancer,” articles and publish yet another “profile in courage” of a woman stricken with the disease who finds that it makes her a better, kinder, more spiritual person.
Every year, about 35,000 American women die from breast cancer. That’s over 100 women a day. Treatment is still limited to “slash, burn and poison,” and we don’t know what causes it.
As I’ve written elsewhere, men tend to set research priorities and be the main clinical researchers. But one of the best known breast cancer researchers is Dr. Susan Love.
This month, Dr. Love has launched a new research initiative dubbed the Health of Women Study (HOW), and she’s asked women’s health bloggers to help her publicize it. According to the study website:
The majority of women who get breast cancer have none of the known clinical risk factors. This means we don’t know what causes breast cancer or how to prevent it. The HOW Study is a first-of-its-kind international online study for women and men with and without a history of breast cancer. We will collect information about your health, your job, your diet, and your family history, among other topics that can help us get a better understanding of breast cancer and its potential causes. Periodically, we will send you questionnaires about anything and everything. All you have to do is fill them out online. It’s that simple. This is a partnership and we need you for the long haul. The more questionnaires you fill out, the more information we will have that can help us have a better understanding of why women get breast cancer.
Anyone over the age of 18 — male or female, with breast cancer or without — can join. There’s no poking, no prodding, no blood samples, no humiliating tests; just some online data collection.
This October, think before you pink .How about joining the study instead? I’ve done it. Will you?