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Mautner Project is committed to improving the health of women who partner with women including lesbian, bisexual and transgender individuals, through direct and support service, education and advocacy. |
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The mammogram controversy: A letter to our community from Dr. Linda Spooner, Chair of the Board of Directors, and Leslie Calman, Executive Director
It is undisputed that mammograms help save lives.
The questions raised by the new recommendations made by United States Preventive Services Task Force --- and immediately rejected by the American Cancer Society and the American College of Obstetricians and Gynecologists -- are about timing (to start at age 40 or 50?), and whether they save enough lives of women in their 40s to warrant the expense, the risk of unnecessary procedures, and the anxieties associated with having a mammogram and learning its results.
The USPSTF used statistical modeling to predict the impact of screenings found over a 10 year period. It found that if a thousand women beginning at age 40 were screened with mammograms, there were small gains in cancer deaths averted, compared to if these women started at age 50. Specifically, their modeling found that 6.1 deaths would be averted, compared to 5.4. The panel judged that difference to be not worth the expense, biopsies and anxieties.
The woman whose life was saved might beg to differ.
And let’s look at those numbers in terms of larger numbers of women screened, using the statistical modeling provided by the USPSTF:
Deaths of women averted by screening in their 40s vs. deaths of women averted by women who start screening in their 50s:
1,000 women 6.1 5.4
10,000 women 61 54
100,000 women 610 540
1,000,000 women 6100 5400
So for every 100,000 women screened in their 40s, as opposed to waiting till their 50s, 70 more women would live. For every one million women, 700 more women would live. Over 33 million mammograms are performed each year in the United States.
The New York Times of 11/18/09 reported that the USPSTF also found differences in years of life gained by women receiving mammograms in their 40s, compared to starting mammograms at age 50:
Years of life gained per
1,000 women 120 99
10,000 women 1200 990
100,000 women 12,000 9,990
1,000,000 women 120,000 99,990
The chief medical officer of the American Cancer Society, Dr. Otis Brawley, has issued a statement saying “With its new recommendations, the [Task Force] is essentially telling women that mammography at age 40 to 49 saves lives; just not enough of them.” In view of that, the American Cancer Society continues to recommend yearly mammograms for women in their 40s at average risk. Because they help save lives.
Mammography is an imperfect tool. On a public policy level, we must demand more funding be made available to find a cure for cancer. Mammography is a diagnostic tool, not a cure, and we need a cure.
But for the task of early and timely detection, mammograms, in conjunction with clinical breast exams, are our best tool.
Research shows us that lesbians receive fewer mammograms – and fewer pap tests for cervical cancer—than heterosexual women. Some have experienced discrimination or been stigmatized because of being lesbian or queer. Some don’t have health insurance. These barriers can be difficult to overcome.
The emphasis in the USPSTF report on sparing women anxiety strikes us as patronizing and dangerous.
Mautner Project is dedicated to getting all members of our community to pay attention to their health and access all appropriate screenings – for cancer, for heart disease, for diabetes – and training medical professionals to treat us with wisdom and respect.
We urge you to talk with your doctor about screenings. If you don’t have a doctor – and many women do not -- screenings can be made available at low- or no-cost. Call Mautner Project at 202.332.5536 for assistance.
To your good health,
Linda Spooner, M.D.
Leslie J. Calman, Ph.D.
Chair of the Board Executive Director
lcalman@mautnerproject.org
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