02 December 2009

A Belated Rant

I was driving and listening to NPR when I heard about the new mammogram recommendations by the United States Preventative Services Task Force, and I strangled myself on some disbelief noises my throat was making and almost rear-ended a car.

If you don't feel like clicking on the links, and reading up about this, here is the verbiage direct from the USPSTF's website:

*The USPSTF recommends biennial screening mammography for women aged 50 to 74 years.

*The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years or older.

*The USPSTF recommends against teaching breast self-examination (BSE).

*The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination (CBE) beyond screening mammography in women 40 years or older.

*The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of either digital mammography or magnetic resonance imaging (MRI) instead of film mammography as screening modalities for breast cancer.

I can barely even respond to this. I've had to calm down and stop shooting my middle finger at this group. While I understand I may not have had this reaction if I didn't know anyone with breast cancer, or had my own scares. Though, I would like to think that as a logically thinking woman, I would still be ticked.

Like so many other situations with health care and insurance for women, this is just one other stab in the eyes that really hurts us. It does nothing for preventative care, and pretty much creates a scenario of reactionary treatment. Why bother finding the cancer until you are 50? Sure, only 7% of women under 40 get breast cancer, but that's tough shit, because our guidelines say 50, and we're sticking to it. Doctors get paid the same and do less, and the insurance companies aren't having to cover as many diagnostic tests. It's a win for everyone BUT the women who may have breast cancer.

Insurance companies are swearing this won't affect current coverage, but I just don't believe it. Or rather, I believe it won't affect policies already in place, but will affect all new and renewed policies. A policy is a contract, so it would be kind of hard for them to change it mid-policy year, but that will not stop them from doing it the next time around. I look forward to that day, don't you? You'll have to pay for your own mammogram until your 50, unless your doctor specifically thinks there is a problem, which by then, that little problem could be a huge problem because a lot of lumps have already metastasized by the time they are palpable to a human; too bad it had been in there since you were 38, but couldn't feel it until you were 43. Would have been nice to have a regular mammogram screening at 40, wouldn't it?

The whole idea that the recommendations were set out to make women feel less anxious about the prospect of having cancer. Right, because I am just a little ol' lady, and my knees buckle and I feel weak at the idea. Thank you for stepping in and saving me from my pesky emotions. I am totally less scared now knowing that I am not even being screened for cancer until I hit 50. What a relief that I can now just put all of that out of mind. Such silly thoughts to have to entertain! I don't even have to examine my own breast now! That was some hard work, and touching myself is so yucky.

Seriously? No, really, SERIOUSLY? How hard is it just to screen us? I always thought 40 was pretty late in the game, and now 50? It smacks of money. That it is not about women's health, but about having to spend all that money on screening tests. Sure, mammography misses a lot of tumors, and it has a lot of false-positives. But should that mean we just use it less? Instead of say, using it while researching better, more sophisticated ways of detecting breast cancer earlier with less false-positives? Why would we just stop screening until 50? Whether it is through a mammogram or self-exam? That is ludicrous.

I know getting a mammogram is scary, uncomfortable and sometimes painful. However, I don't need some group to coddle me and be patronizing. In case no one understands this, women are adults, too. We are not children. Are they going to stop doing digital anal exams on men because it scares men, and they will needlessly worry about having prostate cancer? I doubt it. Will they recommend doctor's to stop checking testicles and recommend men shouldn't feel them either (except for the usual man fondling that has nothing to do with looking for tumors)? I would hate for all those men out there to be worried at the prospect of prostate and testicular cancer--that would really suck if they are having those feelings, so it is probably better that we just stop screening for such things so they don't have to feel the agony of worrying if they have cancer. Obviously if you are not screening for it, it no longer exists. Hi, I'm a baby, you are hiding in another room, obviously you have disappeared off the face of the earth since I cannot see you anymore. Same principal at work here, right? No screening, no worry of cancer! Awesome. Why did I not think of that before? Think of all the doctors' appointments I could have skipped.

What are we doing here? What, exactly, is the point? Who is this benefiting. That's what I want these people to really explain. Do you care about my health? Why would you not want to screen me as early as possible if you care about my actual physical health? Telling me that you want me to feel less anxious, doesn't work for me, because now I'm anxious that I'm not being screened and something could be missed! Is it to save me money? Hmmm, having cancer is pretty expensive, especially when it is invasive due to not looking for it for a decade or more.

I absolutely cannot wrap my mind around this. I will continue to examine myself, and have my doctor send me for diagnostic mammos as needed, and as I get older, if that means I have to make my doctor write me orders for a mammogram and call it diagnostic instead of screening so it will be covered by my insurance, then that is what I will do. I have already gone through the scare of having a tumor, and I think I can handle what ever may come in the future. I'd rather deal with the agony of not knowing if I have cancer or not during the testing process, than just skipping it all together and being oblivious to what is going on inside my body.

Assholes.

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