Follow Up on Do You Really Need a Mammogram

By MARIE MYUNG-OK LEEFEB. 14, 2014

I HAVE never had a mammogram. I’m almost 50 — nearly a decade into the age when the screening is recommended by the American Cancer Society. I’m college educated, adequately insured. And I am the bane of my health care providers. Once, my midwife went so far as to request that I never speak of my decision in any space where other patients might hear.

This week, I was vindicated. On Tuesday, a Canadian study, one of the largest ever done on mammograms, was published in the British Medical Journal. The study found that mammograms did not reduce breast cancerdeaths in women around my age compared to physical exams, and that one in five women screened was overdiagnosed, possibly leading to unnecessary surgery or radiation.

It seems astonishing, but it reinforced what smaller studies had told me, as someone with no family history of breast cancer: that getting a mammogram was unlikely to affect my chances of dying from the disease. What it would do is increase the probability of my mistakenly becoming a breast-cancer patient.

When I was in my late 30s, my midwife suggested I get a baseline mammogram, followed by annual screenings. I was ready to do it. I assumed my research into it would be mere due diligence.

This kind of research was a new habit of mine, born of necessity. When our son was 18 months old, he developed a devastating tumor on his spinal cord. We waited for the doctors to tell us what to do, but the diagnoses and suggestions were scattered — it’s cancer, it’s not cancer, it’s half cancerous, we need radiation, we don’t need radiation, it’s life-threatening, it’s benign. We opted for surgery, and it was deemed a success. Doctors waved us out of the hospital with balloons. But a few weeks later, we were urgently summoned back. The oncologists had decided that he needed another operation to make sure they had removed all of the tumor.

It made me realize that, despite the surety with which the medical professionals had presented things, it was all a best guess based on the available information. So I started doing my own research, to try to make the best decisions for our baby. I soon began to wonder why I didn’t study my own health care decisions as thoroughly as I did his.

So I started looking into mammograms. The more I found, the more I doubted. I was stunned by a 2001 Cochrane review — considered to be the gold standard for evidence-based studies — that concluded, “The currently available reliable evidence has not shown a survival benefit of mass screening for breast cancer.” Everywhere, I saw pink ribbons and the message that mammograms save lives. But no matter how many times I read the numbers, I wasn’t convinced that I should get one.

Over the years, my choice has spurred concern from health care practitioners as well as the person who is most worried about my health: my mother, who, in her 80s, is still a religious mammogrammer. She has described how nerve-racking the post-procedure waiting room is — you shiver in the cooled air until you’re sent home or get the ominous “The doctor needs to talk to you.” One day a few years ago, she was the one called to stay. They had found something “suspicious,” and she felt her world falling apart.

When my mother told me this, the first thing I thought of was the high rates of over- and misdiagnoses, and I told her so. But she still spent over a month in a panic — waiting for the follow-up, which then was somehow done incorrectly and had to be repeated one more time. Finally, multiple painful mammograms later, they concluded it had all been a mistake. And oddly, the false urgency has continued: She has been getting notices reminding her to make an appointment for another mammogram in six months because she is now “high-risk.”

Patients want reassurances. We feel we have to test, so we can find out if we’re sick. We rarely consider that the test itself might make us sick — perhaps through repeated exposure to radiation — or that there are health advantages for the nontester like me, who gains time, sheds stress and potentially dodges the harm of a false positive or unnecessary treatment.

This isn’t the answer for everyone. But as parents and patients, we have no choice but to try to become conversant in medicine, even if it makes some doctors bristle. Our medical experts are an invaluable resource, but in the end, it’s up to each of us how we want to proceed.

I now have a new primary care physician who still refers me to the mammography center, but when he hands me the slip, he smiles and says, “But I suspect you won’t do it,” and I get the feeling he respects my reasons. I wonder if, some day in the not too distant future, he’ll say, “This test actually seems to have more risks than rewards,” and stop handing out that slip at all.

Another excellent article found here:

No Comfort Food for Mental Illness

This is a heartbreaking story I saw on Slate.  Written by  Larry M. Lake.  I admire Mr. Lake.  It takes courage to publicly announce that someone in your family is suffering from mental illness.  Will we ever reach the point where we are not ashamed to talk about depression, drug abuse, alcoholism, bipolar disorder, and all the rest?  Stories like this will help, I'm sure.

"When my wife was diagnosed with breast cancer, we ate well. Mary Beth and I had both read the terrifying pathology report of a tumor the size of an olive. The surgical digging for lymph nodes was followed by months of radiation. We ate very well.

Friends drove Mary Beth to her radiation sessions and sometimes to her favorite ice cream shop on the half-hour drive back from the hospital. She always ordered a chocolate malt. Extra thick.

Our family feasted for months on the lovingly prepared dishes brought by friends from work and church and the neighborhood: chicken breasts encrusted with parmesan, covered safely in tin foil; pots of thick soup with hearty bread; bubbling pans of lasagna and macaroni and cheese. There were warm home-baked rolls in tea towel–covered baskets, ham with dark baked pineapple rings, scalloped potatoes, and warm pies overflowing with the syrups of cherries or apples.

Leftovers piled up in the refrigerator, and soon the freezer filled up too, this tsunami of food offerings an edible symbol of our community’s abundant generosity.

Although few said the word breast unless it belonged to a chicken, many friends were familiar with the word cancer and said it often, without flinching. They asked how we were doing, sent notes and cards, passed along things they’d read about treatments and medications, emailed links to good recovery websites and the titles of helpful books, called frequently, placed gentle if tentative hands on shoulders, spoke in low and warm tones, wondered if we had enough food. The phrase we heard most was: “If there’s anything I can do ... ”

In the following months, after Mary Beth had begun speaking in full sentences again and could stay awake for an entire meal, the stored foods in the freezer ran out, and we began cooking on our own again. Our children, Nick and Maggie, sometimes complained jokingly about our daily fare. “Someone should get cancer so we can eat better food,” they’d say. And we actually laughed. 

* * *

Almost a decade later, our daughter, Maggie, was admitted to a psychiatric hospital and diagnosed with bipolar disorder, following years of secret alcohol and drug abuse.

No warm casseroles.

At 19, she was arrested for drug possession, faced a judge, and was placed on a probation program. Before her hearings, we ate soup and grilled cheese in a restaurant near the courthouse, mere booths away from the lawyers, police officers, and court clerks she might later see.

No scalloped potatoes in tinfoil pans.

This question is rarely heard: “How’s your depression these days?” Maggie was disciplined by her college for breaking the drug and alcohol rules. She began an outpatient recovery program. She took a medical leave from school. She was admitted to a psychiatric hospital, diagnosed, released. She began years of counseling, recovery meetings, and intensive outpatient rehabilitation. She lived in a recovery house, relapsed, then spent seven weeks in a drug and alcohol addiction treatment center.

No soup, no homemade loaves of bread.

Maggie progressed well at the treatment center. When the insurance coverage on inpatient treatment ran out for the year, she was transferred to a “partial house” where she and other women slept at night then were returned by van to the facility for full days of recovery sessions, meals, volleyball games, counseling, and horticultural therapy. This daughter who once stayed as far away from my garden as possible lest I catch a whiff of my stolen whiskey on her breath was now planting a garden herself, arranging painted rocks around an angel statue donated by a counselor, carrying buckets of water to nurture impatiens, petunia, delphinium, and geranium.

Friends talk about cancer and other physical maladies more easily than about psychological afflictions. Breasts might draw blushes, but brains are unmentionable. These questions are rarely heard: “How’s your depression these days?” “What improvements do you notice now that you have treatment for your ADD?” “Do you find your manic episodes are less intense now that you are on medication?” “What does depression feel like?” “Is the counseling helpful?” A much smaller circle of friends than those who’d fed us during cancer now asked guarded questions. No one ever showed up at our door with a meal.

We drove nearly five hours round trip each Sunday for our one weekly visiting hour. The sustenance of food, candy, and fiction were forbidden as gifts to patients at the treatment center. Instead, we brought Maggie cigarettes, sketchbooks, colored pencils, and phone cards. Any beef roasts or spaghetti dinners we ate were ones we’d prepared ourselves or bought in a restaurant on the long road to the center.

Then, late one night in June, Maggie and another patient were riding in the treatment center’s van on the way back to their house after a full day of the hard work of addiction recovery. The number of patients in the partial house had diminished from six a few days before, after a scandal involving small bags of ground coffee some smuggled from the house to the center and sold as though it were cocaine to addicts craving real coffee. (The center, like many, served only decaf.) Dozing off and comfortable in the seat behind the driver, Maggie might have been thinking of those coffee dealers who had been returned to the main facility or dismissed. Or maybe she was thinking about the upcoming wedding of her brother, Nick. A light pink bridesmaid’s dress waited in her closet at our house. Her release from the center was scheduled for two days before she and Mary Beth were to fly to Wisconsin for the wedding.

That night, an oncoming speeding car hit the van head-on.

The medics radioed for helicopters, and soon the air over Chester County, Pa., was full of them, four coming from Philadelphia, Coatesville, and Wilmington, one for each patient. The accident site was soon a garish roadside attraction of backboards, neck braces, IV tubes, oxygen tanks, gurneys, strobing lights, the deep thumping of helicopter blades, and the whine of turbines.

A newspaper picture later showed five firefighters, all in full gear, lifting a woman from a van—only her feet and an edge of the backboard visible. The van’s roof, dark and torn and jagged in the picture, had been removed by hydraulic cutters while the huddled victims, Maggie unconscious among them, were carefully covered with blankets. One of her front teeth lay in a puddle of blood on the ground.

When we saw her in the hospital, her face was a swollen mass of stitches, bruises, and torn flesh. Brown dried blood was still caked in her ears. Mary Beth carefully cleaned it with a licked paper towel, as if she were gently wiping Maggie’s face of grape jelly smudges or white donut powder just before Sunday school. At first, Maggie only remembered headlights, but soon she would mention “a cute EMS tech waking me up,” and the muffled chattering of helicopters.

The day she was released from the hospital, Maggie insisted on returning to the rehab center to complete her program, a heroine in a wheelchair among heroin addicts and alcoholics. On the way there, we stopped at a restaurant for lunch,  where Maggie ate mashed potatoes, a little soup, and sucked a mango smoothie through a straw held carefully where her tooth was missing. Back at the center, we rolled her out to see her garden.

While Maggie was in the hospital, cards and letters filled our mailbox at home. For the two weeks that Maggie remained in rehab, and even while she flew to the Midwest, then wore her pink dress at Nick’s wedding and danced triumphantly with her cousins, offers of food crackled from our answering machine and scrolled out on email: “If there’s anything I can do ... ”