Breast cancer isn't political. But there's continuing debate in the US medical establishment over the proper way to screen for it -- how to test, how frequently, at what age range, what constitutes a positive result, and how should the doctor follow up if the test is positive? The recommended answers to these questions seem to change every few years, and the substantiation behind the answers is often inconsistent.
The same issues bedevil prostate cancer screening.
The science is pretty well established on *generalized* breast cancer screening not improving health outcomes despite being costly. (In short: cancer is rare, tests have false positives that trigger biopsies, biopsies are invasive and can be harmful, overall biopsies and pointless surgery on slow growth cancers do as much harm as cancer.)
But since screening has been framed as caring for women, pointing out the flaws with screening is automatically seen as hating women.
While Ronald Reagan was in office, he had a colectomy for a colon tumor in 1985 (turned out it was not cancer) [0], and his wife had a mastectomy for breast cancer in 1987 [1]:
While Reagan did a lot to try to defund cancer research regardless, the first lady's mastectomy drew a lot of attention to a previously taboo topic.
I don’t think “political” is meant to mean “controversial” here. There were just some extremely successful awareness campaigns for it in the 80s and 90s (to the point where it’s the stereotypical example of an awareness campaign for many of us), so people care a lot about it.
One thing that will cause mammograms to be political, in several countries, is that there's a difference in perception of the downsides vs upsides of such screening programmes, and we're bad at communicating the trade to a population who lack the statistical literacy to understand it intuitively.
So our best shot from a public health perspective is to say "Here's what we recommend for everybody" and pay for that.
All screening programmes have two difficulties, which must be balanced against the benefit, and this trade is somewhat personal, so when the balance is quite fine the arguments can be vociferous as a result.
1. The screening itself may seem unpleasant. One woman may find it a very mild annoyance, a drive ten minutes out of her way, the staff are very pleasant, the scan itself is far less traumatic than a bra fitting, and she receives easy to understand results after not very long and isn't anxious about them; but for another maybe it's an hour's bus journey to the city hospital, the staff there are short-tempered and say she has the wrong paperwork, then another hour in a queue, she feels like she's just meat, squashed around for the convenience of the machine for what seems like forever, and then after anxiously waiting for what seems to be too long the results are confusing to her and she has to have a friend interpret them.
2. Over-treatment is always a problem. Screening by definition detects something that isn't causing noticeable symptoms. If you have a noticeable lump, or mysterious bleeding, you don't need screening you need a doctor's appointment. So a positive screening result might be nothing important. However either you've now got the burden of a diagnosis you ignored or, you accept the medical advice and are treated, even though it's possible (not likely, but possible) that you would have been just fine without treatment.
So, screening programmes are set up based on guessing how to trade these factors plus a third, how much should we spend on this medical intervention? After all, in some sense every dollar doing breast cancer screening is a dollar you don't have to cure blindness in poor orphans (or of course, to bomb somewhere)
If your experience of a screening programme is that it's a minor inconvenience at most, and yet you know people who died of undetected disease, more screening seems like a no brainer. Particularly if you live somewhere where screening stops at age 50, and somebody you know died of undetected disease aged 54, you might reason that the screening should go to age 55 or 60 to detect such cases, no matter the public cost.
On the other hand if your experience is that it's an awful ordeal even when negative, and you know people who spent their last years horribly scarred by surgery as a result of suspected disease but then they died in their sleep from something else anyway, you may feel that there's already too much screening and it should be trimmed back, not to save money but the extra money for other programmes is welcome.
randcraw|4 years ago
The same issues bedevil prostate cancer screening.
unknown|4 years ago
[deleted]
himinlomax|4 years ago
But since screening has been framed as caring for women, pointing out the flaws with screening is automatically seen as hating women.
317070|4 years ago
While Reagan did a lot to try to defund cancer research regardless, the first lady's mastectomy drew a lot of attention to a previously taboo topic.
[0] https://www.nytimes.com/1985/07/16/us/reagan-s-illness-medic... [1] https://www.latimes.com/archives/la-xpm-1987-10-18-mn-15261-...
dekhn|4 years ago
Back when I was a life scientist the best advice I got was to work on diseases the family members of congresspeople had.
kaesar14|4 years ago
ars|4 years ago
This is not a "weird relationship" thing, rather women got organized and: https://en.wikipedia.org/wiki/Breast_cancer_awareness
SpicyLemonZest|4 years ago
tialaramex|4 years ago
So our best shot from a public health perspective is to say "Here's what we recommend for everybody" and pay for that.
All screening programmes have two difficulties, which must be balanced against the benefit, and this trade is somewhat personal, so when the balance is quite fine the arguments can be vociferous as a result.
1. The screening itself may seem unpleasant. One woman may find it a very mild annoyance, a drive ten minutes out of her way, the staff are very pleasant, the scan itself is far less traumatic than a bra fitting, and she receives easy to understand results after not very long and isn't anxious about them; but for another maybe it's an hour's bus journey to the city hospital, the staff there are short-tempered and say she has the wrong paperwork, then another hour in a queue, she feels like she's just meat, squashed around for the convenience of the machine for what seems like forever, and then after anxiously waiting for what seems to be too long the results are confusing to her and she has to have a friend interpret them.
2. Over-treatment is always a problem. Screening by definition detects something that isn't causing noticeable symptoms. If you have a noticeable lump, or mysterious bleeding, you don't need screening you need a doctor's appointment. So a positive screening result might be nothing important. However either you've now got the burden of a diagnosis you ignored or, you accept the medical advice and are treated, even though it's possible (not likely, but possible) that you would have been just fine without treatment.
So, screening programmes are set up based on guessing how to trade these factors plus a third, how much should we spend on this medical intervention? After all, in some sense every dollar doing breast cancer screening is a dollar you don't have to cure blindness in poor orphans (or of course, to bomb somewhere)
If your experience of a screening programme is that it's a minor inconvenience at most, and yet you know people who died of undetected disease, more screening seems like a no brainer. Particularly if you live somewhere where screening stops at age 50, and somebody you know died of undetected disease aged 54, you might reason that the screening should go to age 55 or 60 to detect such cases, no matter the public cost.
On the other hand if your experience is that it's an awful ordeal even when negative, and you know people who spent their last years horribly scarred by surgery as a result of suspected disease but then they died in their sleep from something else anyway, you may feel that there's already too much screening and it should be trimmed back, not to save money but the extra money for other programmes is welcome.
cwmma|4 years ago
ars|4 years ago
cratermoon|4 years ago
hellbannedguy|4 years ago