What's Best for the Girls?

A few years ago, I went with my mom while she had a mammogram. It was traumatic. My mom and I were taken into a room with a six-foot-tall machine. She had to put on one of those peak-a-boo paper gowns and then I had to hide behind the lead screen with the nurse. My mom's breasts, to be blunt, are fairly ample, and she had to heave them up on this vice-like apparatus that clamped down and squeezed them and then shot them through with radiation. The machine looked like it had been built in the 1950s. It was the size of a phone booth and had absolutely nothing to do with women's bodies. No attempt whatsoever had been made to make this technology amenable to the bodies with which it was designed to work. I find it extremely hard to believe that this technology could not have been improved in the last 59 years or so, and I certainly cannot imagine a man sticking his nuts into a machine like this.

A recent article in the New York Times suggests this annual torture may not be required to keep your girls healthy. Apparently, in Britain, regular mammography has been critiqued for resulting in over-diagnosis of non-fatal cancers. According to the article, for every one woman diagnosed by a mammogram and successfully treated for breast cancer, 10 women are diagnosed with a slow-growing, non-fatal form of breast cancer. However, the cancers cannot be distinguished, so it's impossible to tell if the cancer is the more benign, slow-growing type. A British panel concluded that early detection may not make a difference in survival rates of women with particularly aggressive cancer, and that only one death would be prevented after screening 800 women over 14 years.

Militant breast screening has been under fire of late in the culture zone. I heard an interview on NPR recently with a doctor who suggested that daily breast self-exams might not be necessary. More interesting than the interview itself was the reaction by women. Listeners called in en masse to complain about the interview, and to "testify" to the power of the self-exam to save lives. Perhaps women feel like breast self-exams give them power or control over a mystified illness. I wonder, though, if they would be so quick to defend mammograms?

My skeptical self also has to wonder about the differences between American and British approaches to cancer prevention. In the U.S., women typically begin receiving annual mammograms at age 40; in the UK, at age 50, women begin having mammograms every three years. The article in the Times doesn't mention self-exams, but I find it interesting that some British physicians are discouraging overuse of mammography, while some American doctors advocate less self-exams. What does this say about our health care systems--would American doctors discourage the annual procedure if our health system was not profit based? How do our health care systems determine what constitutes prevention, and even how we understand what it means to be healthy?

I have a history of breast cancer in my family, and my mother thinks I should begin having mammograms this year when I turn 35. I think this year I'll compromise and start doing breast self-exams. I'll hold off on the mammograms until they update that radiation torture chamber, and maybe even until we have universal health care.