Health Bulletin, Chapter VI: Ladies Night, part 2
Osteoporosis
Osteoporosis can affect both men and women, but women are affected much more often due to decreased average bone mass. Estrogen plays a protective role for bone in women, and after menopause the bones become vulnerable to fracture. Even though osteoporosis hits later in life, the best prevention measures are implemented early in life. Women's bone density peaks in the late 20s to 30s; after that, it can only go down. It has been shown that higher peak bone density decreases the likelihood of developing osteoporosis later in life, so loading up on calcium, vitamin D, and weight-bearing exercise (i.e. running, not swimming) and not smoking as a young woman is more effective at fending off osteoporosis than as an older woman whose bone density is already declining (but older women should still follow all these guidelines to prevent further loss).
Breast cancer screening
There is study-based evidence, based on trials and retrospective studies and actual math. This evidence tends to convince clinicians and scientists to create guidelines that theoretically should save lives at minimal cost. Then there is anecdotal evidence, in which some person screams, "but I did a self breast exam and found cancer and I would have died otherwise!" Unfortunately, this kind of evidence tends to be more effective in congress, which is responsible for implementing nationwide preventative measures. Furthermore, the general misunderstanding by lawmakers of the effectiveness of our currently available methods, lack of knowledge of breast cancer pathology, and the sensitivity of the subject of breast cancer as a feminist issue has led to complete rejection of clinical recommendations by lawmakers in the face of growing evidence against self exams and early mammograms.
Here's the science. Cervical cancer is 100% preventable because the tissue is easy to access and there is a clear precancerous lesion that is easy to find and identify, plus we have an inexpensive screening method that is easy to implement. Breast cancer, on the other hand, is difficult to get to and rarely has a precancerous stage that predicts cancer development. There are a number of other changes in the breast that are normal and may resemble cancer (nodules, pain, masses) but are totally benign. Plus, by the time such features of cancer are actually discovered, it is often late in the course; in cancer treatment, timing is very important.
There is no evidence that suggests that breast self-exams (BSE's) save lives. The likelihood of finding a mass that wouldn't have been discovered otherwise, be it by just showering normally, or getting an exam by your doctor, or getting a mammogram, is not known but generally believed to be extremely low. It is much more likely to produce panic, unnecessary psychological distress, and an expensive and stressful diagnostic follow-up over normal or non-cancerous tissue, and these tests are not without risks and morbidity (usually, breast tissue must be removed and analyzed using a thick tissue-acquiring needle). In fact, Canada has implemented a policy which advises against breast self-exams, but a similarly logical step probably won't occur in the US, probably ever.
Similarly, there is little evidence that annual mammograms between age 40 and 50 save lives, either. Breast cancer is much more likely with increasing age, and 40-50 is right at that grey area where screening may be effective, but may also end up being a huge waste of money. Mammograms are expensive. Mammograms every year or two are expensive. Mammograms every year or two for all women in the country are even more expensive, and even though breast cancer strikes at earlier age groups as well, the numbers simply don't justify the risks and cost. You can imagine that congress shat somewhat of a brick when this was presented and the medical community suggested restricting mammogram screening to women 50 and older. Of course, the lawmakers rejected it. Currently, it is up to the individual physician to decide whether to screen patients for breast cancer by mammogram in this age group.
Mammograms every two years after the age of fifty have been shown to save lives.
As an aside, I don't mean to marginalize the importance of breast cancer screening or of breast cancer. It is responsible for the second-highest number of female cancer deaths (first being lung cancer) and is often very difficult to treat once diagnosed. But its importance should not cloud judgment about health care management, which should be based on data, not stories.
Next up: back pain and headaches
Osteoporosis can affect both men and women, but women are affected much more often due to decreased average bone mass. Estrogen plays a protective role for bone in women, and after menopause the bones become vulnerable to fracture. Even though osteoporosis hits later in life, the best prevention measures are implemented early in life. Women's bone density peaks in the late 20s to 30s; after that, it can only go down. It has been shown that higher peak bone density decreases the likelihood of developing osteoporosis later in life, so loading up on calcium, vitamin D, and weight-bearing exercise (i.e. running, not swimming) and not smoking as a young woman is more effective at fending off osteoporosis than as an older woman whose bone density is already declining (but older women should still follow all these guidelines to prevent further loss).
Breast cancer screening
There is study-based evidence, based on trials and retrospective studies and actual math. This evidence tends to convince clinicians and scientists to create guidelines that theoretically should save lives at minimal cost. Then there is anecdotal evidence, in which some person screams, "but I did a self breast exam and found cancer and I would have died otherwise!" Unfortunately, this kind of evidence tends to be more effective in congress, which is responsible for implementing nationwide preventative measures. Furthermore, the general misunderstanding by lawmakers of the effectiveness of our currently available methods, lack of knowledge of breast cancer pathology, and the sensitivity of the subject of breast cancer as a feminist issue has led to complete rejection of clinical recommendations by lawmakers in the face of growing evidence against self exams and early mammograms.
Here's the science. Cervical cancer is 100% preventable because the tissue is easy to access and there is a clear precancerous lesion that is easy to find and identify, plus we have an inexpensive screening method that is easy to implement. Breast cancer, on the other hand, is difficult to get to and rarely has a precancerous stage that predicts cancer development. There are a number of other changes in the breast that are normal and may resemble cancer (nodules, pain, masses) but are totally benign. Plus, by the time such features of cancer are actually discovered, it is often late in the course; in cancer treatment, timing is very important.
There is no evidence that suggests that breast self-exams (BSE's) save lives. The likelihood of finding a mass that wouldn't have been discovered otherwise, be it by just showering normally, or getting an exam by your doctor, or getting a mammogram, is not known but generally believed to be extremely low. It is much more likely to produce panic, unnecessary psychological distress, and an expensive and stressful diagnostic follow-up over normal or non-cancerous tissue, and these tests are not without risks and morbidity (usually, breast tissue must be removed and analyzed using a thick tissue-acquiring needle). In fact, Canada has implemented a policy which advises against breast self-exams, but a similarly logical step probably won't occur in the US, probably ever.
Similarly, there is little evidence that annual mammograms between age 40 and 50 save lives, either. Breast cancer is much more likely with increasing age, and 40-50 is right at that grey area where screening may be effective, but may also end up being a huge waste of money. Mammograms are expensive. Mammograms every year or two are expensive. Mammograms every year or two for all women in the country are even more expensive, and even though breast cancer strikes at earlier age groups as well, the numbers simply don't justify the risks and cost. You can imagine that congress shat somewhat of a brick when this was presented and the medical community suggested restricting mammogram screening to women 50 and older. Of course, the lawmakers rejected it. Currently, it is up to the individual physician to decide whether to screen patients for breast cancer by mammogram in this age group.
Mammograms every two years after the age of fifty have been shown to save lives.
As an aside, I don't mean to marginalize the importance of breast cancer screening or of breast cancer. It is responsible for the second-highest number of female cancer deaths (first being lung cancer) and is often very difficult to treat once diagnosed. But its importance should not cloud judgment about health care management, which should be based on data, not stories.
Next up: back pain and headaches