CHRIS MUCKLER
Martina Navratilova has defeated many opponents and, hopefully, due to early detection provided by a mammogram, she will again prevail as a champion. Navratilova publicly announced this month that she was recently diagnosed with breast cancer. And though President Obama signed legislation on March 23 for health care reform, there is little discussion regarding breast cancer until a celebrity announces she has the dreaded diagnosis.
Cancer is one of the most feared health issues. Most of us have either personally survived it or witnessed the struggles of a loved one or celebrity who endured its wrath. According to the American Cancer Society, cancer is the second-leading cause of death among women and breast cancer is the second-leading cause of cancer deaths for women.
Mammograms revolutionized breast-cancer detection, yet many women do not know that in November 2009 the United States Preventive Services Task Force (USPSTF) – the organization that evaluates evidence and issues recommendations for health-prevention services – changed the recommendations for mammograms and breast health. The USPSTF now recommends against routine screening mammography in women ages 40-49 and against teaching women how to perform breast self-exams.
As a certified registered nurse anesthetist and doctoral candidate, I am among those opposed to the new guidelines. Previous guidelines advised biennial mammogram screening beginning at age 40. Did you know that by age 40, an estimated one in 68 will develop breast cancer? According to Imaginis.com, by age 50 the incidence narrows to one in 37.
Considering the disease’s prevalence and the fact that I am approaching 40, I am quite concerned – not only for myself, but for my daughters. I expect those responsible for making the changes have not been privy to a nurse’s perspective. In providing ongoing bedside care, what comforting words can I possibly offer to a bald, 32-year-old woman with painted eyebrows, a vascular access port on her chest and prosthetic breasts (that don’t fill the empty void in her bra or her heart) as she wretches over the toilet and prays for her children? As an onlooker, the disease appears brutal. Imagine living it.
Under the current USPSTF recommendations, it is likely that cancer will be diagnosed in later stages, which will decrease chances for survival; increase the number of exposures to chemotherapy, radiation and other harmful medications; and increase the costs of health care for this population. The task force has concerns for unnecessary costs, false positives and unnecessary breast biopsies; but with a strong family history and breast-tissue changes, a mammogram seems a necessary price to pay.
The ramifications of cancer are not avoidable but potentially reducible if first suspected by a free self-exam. It is not prudent to devalue this free and simple method for early detection of breast-tissue changes. Breast self-exams allow women to become familiar with their bodies in order to detect changes.
Deterring women from this is incomprehensible. Early detection is the key to survival.
Despite the new guidelines, I encourage women to self-examine, self-educate and evaluate your risk factors and family history with your health-care provider to determine the need for a mammogram. Make an informed decision with which you can live. Is waiting until you’re 50 worth it? That’s a choice you’ll have to make.
Chris Muckler is a certified registered nurse anesthetist in Durham and a doctoral candidate at the Duke University School of Nursing.