I had my annual mammogram last week. It wasn’t the worst thing in the world, but it wasn’t pleasant. My biggest takeaway was cold: The hospital was cold, the changing room was cold, the mammogram machine was cold, the technician’s hands were cold. It wasn’t a great way to start the day.
Still, I perked up when, a few days later, the letter came announcing that my results were normal. Again. They’ve been normal for the past 17 years—years in which I’ve faithfully been trekking into my local hospital to have the test done.
I’m not at high risk for breast cancer, particularly. There are a few instances on my father’s side, none that I know of on my mother’s side. It doesn’t seem likely I’m a carrier of the BRCA genes that have women like Angelina Jolie and Christina Applegate preemptively having their breasts removed. Sometimes it crosses my mind: Do I really need this test this often? Then I hear a story like that of 40-year-old TV reporter Amy Rohrbach, who reluctantly underwent an on-air mammogram on Good Morning America and found out she had cancer. The mother of five subsequently had her own double mastectomy.
It’s easy not to want the test … until you find out the test saved your life. A new study from researchers at U.C. San Francisco says every-other-yearly mammograms for women ages 50 to 74 are just as effective at screening for cancer as annual testing—and could save $4.3 billion a year in U.S. medical costs. Money talks, right? But the American Cancer Society continues to recommend annual mammograms. Meantime, breast self-examination, which has been drummed into me for decades as a weapon against cancer, has been shown not to reduce mortality from the disease; recommendations on it now vary wildly.
Which brings us to UCSF professor of surgery and radiology Laura Esserman, senior author of a new analysis of best practices for mammography. Her goal: to come up with guidelines “based on the scientific evidence to date to maximize patient benefit and minimize harm but also result in far more effective use of resources”—in other words, to take into account both the money and results. It’s the sort of hardheaded cost/benefit analysis Obamacare is intended to promote: medicine based less on emotion (i.e., fear) and more on fact.
Her recommendations, being put into practice this year at University of California Health System hospitals, are for every-other-year mammograms for women ages 50 to 74. The money saved by this reduction in frequency can go toward comprehensive breast-cancer risk assessment for younger women, with analysis of genetic predispositions and breast density, and individualized courses of examination based on those results. The outcomes of all this testing will be put into a database and analyzed, to compare the projected cost savings—as much as $8 billion annually—with cancer and survival rates. Says Esserman, “We need to figure out how to do more when it’s needed, and less where more only adds a burden and morbidity.”
It’s a clear-eyed approach to a fraught topic. I’d welcome the chance to reduce my mammogram visits. Of course, if in between my tests I happened to develop an aggressive form of breast cancer, I’d be pissed as hell at Laura Esserman—as the vituperative back-and-forth comments on this NPR story about her research show.
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