In Tuesday's What We Missed, we briefly mentioned the new USPST mammogram guidelines, which now recommend that women begin getting regular mammograms at age 50 rather than at 40, and that the frequency be reduced from annual to once every two years.
The guidelines have been criticized for being "patronizing" and "dangerous" for women's health, but there's one community that is put at particular risk by the guidelines but isn't receiving as much attention: black women.
My colleague and former classmate Ashton Lattimore writes on News One that "the potential impact of these guidelines on black women is a really important piece of the puzzle that so far hasn't gotten much discussion."
In her piece, she interviews Dr. Marissa Weiss, a leading breast cancer specialist and founder of BreastCancer.org, who confirms that African-American women are more likely to get breast cancer than white women when they're under age 40. (The U.S. Department of Health reports that Black women ages 35 to 44 have a breast cancer death rate more than twice that of white women in the same age group.)
The new guidelines, then, as Weiss points out, "would pass over the time of greatest risk for African-American women."
Lattimore also points out that triple negative breast cancer - an aggressive form of cancer- disproportionately impacts Black women, and that Black women are already diagnosed with later stage breast cancers more frequently than other groups.
Looks like perhaps the only good that will come out of these guidelines is increased awareness about the importance of ignoring them completely, as well as the importance of women- especially black women- undergoing regular and early mammogram screenings.
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Or, you could actually pay attention to what the guidelines said, which is absolutely not that women with risk factors should wait till 50.
L/y/i/n/g Misrepresenting the task force's recommendations to earn a seat on the demagoguery bandwagon is beyond "patronizing" and "dangerous."
This.
And the real question is why Feministing is giving free publicity to such demagoguery.
In a culture that is evidently racist and sexist in myriad ways, why focus on enemies of our own invention? Giving the editors the benefit of the doubt, I will assume that they have not read the new guidelines themselves and are relying on inaccurate media reports of their contents. Still, I have to wonder if this and many sites wouldn't do themselves a great service by slowing down the pace at which new front page posts are added in favor of a more thorough vetting process.
Revising the guidelines puts no one in danger. The false sense of security resulting from early, yearly mammograms certainly does put women in danger.
The problem is the data on efficacy of mammograms on reducing mortality is not clear cut, especially when talking about mammograms on younger breasts. The public has been fed the message that early detection, via mammogram, will absolutely save the life of any individual woman. The problem is that mammogram != detection, and that has been known for many years now. Mammograms are a form of x-ray, and they are not very good at imaging high-density breasts such as are typical in younger women. The image of a 40 year old breast is very, very difficult to interpret.
It's also not clear just how effective BSE's are at detecting tumors - hence revised guidelines for those as well.
I hate to break to everyone, but medicine is hard. There are almost no clear cut answers for anything about the human body, and the longer we study it, the more we find that we were mistaken. There was never any data in the first place to indicate that early mammograms would save lives - it just seemed fairly intuitive: find it sooner, get it out. Now that there is copious data on outcomes from early mammograms, what seemed intuitive is, in fact, wrong.
Ignoring the guidelines will not help anyone. Instead, try understanding the data that the guidelines are based on and realize that if you decide to get a mammogram starting at age 40, you are not necessarily going to diagnose breast cancer because of it.
I agree with the two posters above. If African-American women are at higher risk, the recommendation is that they continue to get mammograms at 40.
Citing the fact that African-American women are more likely to die from breast cancer does not support the argument that all women should be screened starting at 40. As I understand it, the death rate is due to a combination of factors, including lack of timely access to mammograms - even when lumps are found - and delays in treatment. Having everyone screened preventatively will not help the women who need to get mammograms get access more quickly.
The media has misrepresented the study's conclusions.
It said that women without risk factors (family history, ethnic/racial background, late/no childbearing, etc.) can wait, not that ALL women should.
There's no history of any sort of cancer in either my mother's or father's family; it'll likely do me no good to start screening early. One of my aunts-by-marriage, however, has breast cancer and her mother and sister have as well. My cousins *should* get screened early and often.
I will have to check with my mom (she works for the American Cancer Society)
How exactly are changes to the guidelines "patronizing"? Is the patriarchy writing the guidelines???
The idea is that the task force is overly concerned about false positives, not because it's a horrifying and traumatic diagnosis, but because of vapors and fainting couches.
Exactly. And I understand the feeling because I've thought that before about other guidelines*. But in this case, they are talking about serious consequences. Its not like a false positive is found out immediately and you go along with your life-- it means lots of expense and serious stress and worry, and most likely invasive tests and possibly other treatments that can harm you. That kind of stress can also negatively impact your health, not just your mental health.
And if its patronizing, its patronizing to men too, because they use similar language when talking about when to have prostate exams.
*(like the ones saying you have to be on two forms of birth control to take acutane, even if you're, say, lesbian and willing to get an abortion if you were to somehow get pregnant)
According to many major medical sources, most women with breast cancer have no known risk factors other than simply being women. The number one risk factor: being a woman. When the recommendations say women with risk factors should still get checked, it's vague. Because if you look at the risk factors as I've seen them on their literature... being a woman, a family history, women of color, overweight/obese women, beginning your menstrual cycle at an early age, having your first child after 30.... it would seem that a whole lot of women would fall under at least one of those categories. Will all of these risk factors be considered when women are being advised as to whether or not to go for screening?
Regardless, I still think this comes down to women having the maximum amount of options when it comes to their ability to make medical decisions. Women who don't have risk factors and don't think a mammogram is necessary can choose not to get one. But if this recommendation causes insurance companies to deny women under 50 with no known risk facts who CHOOSE to be tested, I will be pissed.
According to many major medical sources, most women with breast cancer have no known risk factors other than simply being women. The number one risk factor: being a woman. When the recommendations say women with risk factors should still get checked, it's vague. Because if you look at the risk factors as I've seen them on their literature... being a woman, a family history, women of color, overweight/obese women, beginning your menstrual cycle at an early age, having your first child after 30.... it would seem that a whole lot of women would fall under at least one of those categories. Will all of these risk factors be considered when women are being advised as to whether or not to go for screening?
Regardless, I still think this comes down to women having the maximum amount of options when it comes to their ability to make medical decisions. Women who don't have risk factors and don't think a mammogram is necessary can choose not to get one. But if this recommendation causes insurance companies to deny women under 50 with no known risk facts who CHOOSE to be tested, I will be pissed.
Really, completely ignoring the best available evidence, international best practice, the recommendations of the World Health Organisation and U.S. expert opinion is what you advise?
How responsible.
A breast cancer surgeon weighs in on the debate here: http://scienceblogs.com/insolence/2009/11/really_rethinking_breast_cancer_screenin.php
And Slate breaks down the stats here:
http://www.slate.com/id/2236028/ e.g.: "For the average 40-year-old woman, annual mammography for a decade increases one's overall chance of breast cancer survival from roughly 99.7 percent to 99.8 percent."
While I enjoy reading Feministing, it is clear that the editors here do not understand what the revised guidelines are about and are starting to look foolish. They should also reconsider tossing around the charge of patriarchy so freely.
http://scienceblogs.com/insolence/2009/11/obamas_makin_death_panels_for_your_mama.php
Whatever your opinion on the validity of the new guidelines, it’s valuable to talk about what they mean for African-American women, who have rather consistently and systematically been marginalized or under-served by the American health care system.
I always appreciate constructive criticism of my posts, but I draw the line when they demonstrate disregard for the black female experience.
ALL black women should IGNORE these guidelines, and that in and of itself is very newsworthy, and something that is not being discussed on Slate or on the science blogs website.
Thanks for reading.
Who in this thread has "demonstrat[ed] a disregard for black female experience?" What are you talking about? That black women have been marginalized and under-served by our health care system is a truism, but what does that have to do with the new guidelines? You are very bold to make pronouncements about who should or should not get screenings, since you have no relevant training in the field. Also, I clicked on the link and read he article from the expert you cited. What in the world is "white women’s breast cancer?" Is she serious with that term?
Lori, the articles that others have posted regarding this issue have mentioned that Canada and Europe have had, for a while, recommendations that are similar to the ones that were just released here. Do you have any information on how that's affected black women living in those places? Is there any guidance black women in the US can take from them?
I have to disagree that black women should ignore the guidelines, since the guidelines recommend more/earlier mammograms for women in higher risk groups, and black women are a higher risk group. Therefore, the guidelines recommend more/earlier mammograms for them.
I think the problem here is that the media isn't reporting that black women are a high-risk group, or telling them how the guidelines affect them. And by problem, I mean GIGANTIC problem.
It's almost like they are just assuming that all their audiences are white. /snark
I guess what I don't get with this thread of comments is why so many people are angry that there is a backlash against these guidelines. It's not as if it is just a group of idiots out there questioning the findings and fearing the ramifications of them. Major organizations, major cancer treatment hospitals, and now the US Health and Human Services Secretary are all telling women to keep doing what they have always been doing.
This is not clear cut and I don't think women's health is served by people wanting everyone to just follow the guidelines and stop the questioning.
First, I have read ALL the guidelines. So please don't charge me with that.
Second, while I understand that Europeans and Canadians have been under similar guidelines for a while now, I think we can all agree that citizens in those countries have better access to healthcare and way less hassle when it comes to coverage. I think how these guidelines will play out in real life matter and that is why I think Lori wrote this post in the first place. Science doesn't exist in a vacuum, especially and particularly with this task force, which the insurance industry uses to determine who gets care for what.
Third, on that same note, while I can respect the fact that the Task Force leaves room for exceptions to the 50+ guideline, what counts as high risk is vague. And that vagueness makes me nervous because insurance companies in this country that work for profit, find every reason to deny people coverage, even when they are what most of what would consider "high risk" but the insurance companies don't. I know this from personal experience in my family dealing with BRCA, breast cancer, and insurance. And we have great health insurance. So, while it may look nice and pretty on a website with its written up results and charts, what those mean to those of us concerned with this issue and what they mean to the groups that are actually going to pay for treatment are two totally different things.
This is not me denying the traumatic experience of false-positives and "unnecessary" biopsies, harms, though, that the Task Force even calls "transient". Aleks and I have written back and forth on this and even if this sounds crass, people who go through false-positives and "unnecessary" bioposies don't actually end up with cancer and to me, instead of being upset by the process, need to be incredibly thankful that the process stopped there. For too many people in my life there were years of treatments that followed and some did not survive in the end.
This is simply me being personal about this because I know at least one woman without any high risk factors whose breast cancer was diagnosed pre-50 from a mammogram (but now their diagnosis has become my own family history and, thus, qualifies me for earlier mammograms).
And like I have said other places, I certainly hope that I am wrong about this having a negative impact on women's health. But I can't deny that it certainly troubles me and I am not the only one.
I guess what I don't get with this thread of comments is why so many people are angry that there is a backlash against these guidelines.
I can't speak for anyone else but I don't like the reflexive demonizing of the US Preventive Services Task Force. They're not monsters and they're not "patronizing" women, they're not ignoring black women or trying to cheat women in their 40's out of their share of the healthcare resource pie.
Seems like folks are missing part of Lori's point here. Black women are more likely to get subpar medical treatment--both historically and to date. They are often invisibilized in medical guidelines, where whiteness is the so-called "norm" in many studies and less is understood about the physiological and cultural influences of, as Lori put it "black experience," that influence health outcomes.
If all black women are at a higher risk for breast cancer, than it seems they should ignore the new guidelines (as stated in multiple sources). But will black women know this if they don't even know they're at a higher risk? Why would they know when the coverage of these new standards doesn't say a word about different risk factors for black women? (Note one third of women worldwide don't even have access to mammograms.)
Inequality in health care was mentioned, but Lori's main point seemed to be the bold section of the last paragraph. The bit where she told people to ignore the guidelines completely.
If all black women are at a higher risk for breast cancer, than it seems they should ignore the new guidelines (as stated in multiple sources). But will black women know this if they don't even know they're at a higher risk?>
The point here that, as I understand it, a lot of commenters have made is that black women who continue to get mammograms beginning at age forty ARE NOT IGNORING the guidelines. Rather, they are following them.
The guidelines advise at-risk patients to begin at age 40, and black women are considered at-risk patients. Presumably, since that is the case, a black woman's PCP will tell her she needs a mammogram at that age -- just as my PCP tells me that I, as a young white woman with a family history of breast cancer, will need one then, too.
Of course, that is not to say that every black woman HAS a PCP. The issue of equal access to primary care for American women across races is a very real one -- but it's one that I think the Feministing editors would do well not to conflate with or blame on government-issued guidelines for mammography.
I'm troubled, too, by Lori's encouragement of women to ignore government guidelines for mammography. I understand the urging of healthy analysis or skepticism of such guidelines, but it seems willfully, well, ignorant to tell women to ignore them outright.
Yes, that is the other main point. If black women are more at risk, then the guidelines SAY that they should get earlier screening. So if they get earlier screening, they are following the guidelines. It makes no sense to say they should ignore the guidelines when the guidelines in fact tell them to do exactly what you want them to do.
Now, maybe the problem is that the mainstream media isn't pointing this out, but I don't see any of the non-mainstream media writers here at Feministing pointing it out either.
Why would they know when the coverage of these new standards doesn't say a word about different risk factors for black women?
Actually, when I first heard this news on the radio they DID specifically mention that black women are one of the higher risk populations that should get earlier screenings.
They are often invisibilized in medical guidelines, where whiteness is the so-called "norm" in many studies and less is understood about the physiological and cultural influences of, as Lori put it "black experience," that influence health outcomes.
The "norm" here is not "white people only." The norm is people WITHOUT EXTRA RISK FACTORS. Race is one variable. But it's just as ridiculous to claim "the patriarchy is ignoring the experience of women with a family history of breast cancer!" as it is to accuse this study of trying to specifically ignore black women.
I'm a feminist and a scientist, and it does bother me when writers on this blog don't get science (or statistics) straight.
Yeah. Perils of women interested in feminism winding up in women's studies classes that don't seem to do a very good job of explaining statistics, at a guess. In fact, from what I can tell feminism itself (or at least the common strains of feminist thought) is actually slightly anti-scientific.
Think about the prioritisation of anecdotal information over actual statistics, and consider the implications given all the biases (confirmation bias, bias due to prior beliefs, bias due to social influences, non-representative sampling) that will affect any conclusions. Y'know, all the reasons scientists have to use statistics in the first place. Interesting, isn't it?
Still, at least feminism isn't actively, proudly anti-science. Well, not anymore, anyway.
I'm really surprised and disappointed at all the posts here condemning these new guidelines. I wish I had time to write up a long post explaining conditional probability and citing sources. Since I don't have time to do it properly, I'm going to hold off until I do-- but I wish all the people ranting about this would take a statistics and probability class first. One of the classic examples shows that if you start with a test that is "99% accurate" it doesn't really mean what you think it means-- you also need to include the prevalence of the disease in the population in your formula. Bayes Law shows that even if a test is 99% accurate, if the disease is rare in the population in general, the actual chances of having the disease given a positive test are really low. Because of this, doing tests for diseases that you are at very low risk for causes more harm than good. Also please note that the guidelines still say that if you have risk factors you should still get tested-- they are only saying that if you have no risk factors, getting the test is statistically more likely to cause problems for you than not getting the test.
Curious-- who's deciding which posts have comments screened and which don't? A lot of posts lately seem to have them screened but this one doesn't. It would be nice to know up front which is which before posting.