(Untitled)

[docorion]

An essay in this month's Health Affairs is compelling reading, at least for folks like me. In brief, the author describes the reasons why she, despite a positive family history, does not get an annual mammogram.

The following paragraphs encapsulate the argument nicely, I think:

"If 2,000 women are screened regularly for ten years, one will

Comments

[anaisdjuna]

Hmmm. What are the chances of harm? I'm ok with needless worrying to be sure. I've actually been there. I was in Holland and had a big painful lump that I found myself and saw about at the blessed Witte Jassen (doctors for po' folks and illegal immigrants such as myself). I went for a sonagram screening and they were so sweet and caring and cool and Dutch that they gave a broke sister a mammogram for free. (peace be upon them) The idea was that I should get a biopsy cuz it looked scary. So scared I was, I went home to the US of Outrageous Medical Costs to get it seen about in my own language at my oncology nurse aunt's doctor. (same aunt who'd had a pretty awful bout with it because she did not get herself screened in time though she knew better)

Being insurance free at the time, I put my big girl panties on and had a lumpectomy A-FREAKIN'-WAKE because that's what I could barely afford (with Daddy's help). It actually wasn't so bad 'til I saw the look on homie's face as he started to think it was cancer and at the last mo' decided not to use the same stuff to chop out the mole on my stomach which was slated for ectomy-ing :-( (miss that thing).

Then there was the wait. It was terrifying that's for sure. Didn't help that one of my father's stalker victims told me that "well you probably have cancer" - whatta dumb bitch. Just about put my bf out of the car because he was acting up on the way to find out. When told that I couldn't deal with his drama at that moment, but would come back to get him at the McDonald's of his choosing after I'd gotten my diagnosis he straightened his priorities out. There's very little room for other stuff when you're waiting on that test that's for sure.

I think though that I'd take that stress over missing a mark. Wouldn't want to be treated for cancer if I don't have it though. Does that really happen that often? Sure you might get mis-biopsied, but they don't go radiating people and removing breasts without positive tests, yes?

[docorion]

That's a diagnostic mammogram, and needs doing. The discussion which is generating all the heat is about *screening* mammograms. You had a diagnostic mammogram, which is a different beast. (Difference: you had an obvious lump or other reason to get a mammogram; this gives you a higher probability of disease right out of the gate. And "probability of disease" is a factor in the equation which governs the predictive value of a test (any test, not just mammograms).

And as for testing-true, they don't operate or radiate without testing-but you assume (as do most people, including physicians) that the tests are infallible. They are not. *No* test is infallible; they all have a sensitivity, a specificity, and a positive and negative predictive value.

And there is some question, especially for breast cancer, whether the test is even as good as we think it is. The volume of testing done mandates a high volume methoidology, and when you move to that, something tends to suffer. (Consider: would you like McDonalds, or a burger made by hand at a nicer place than McDonalds? Both are beef patties fried on a griddle, but one is almost certain to be better than the other. So with testing; high volume has certain tradeoffs, and we're not sure what we've traded away is worth it).

So had you asked my advice at the time (and likely we didn't know one another), I'd've recommended you stay in the Koningkrijk der Nederlanden, which has talented doctors who know what they're doing, and had your workup done there.

[docorion]

Also? You know "Witte Jassen" means "White Coats" in Dutch, right? :-)