That's not a word one hears much these days, but calm is what some are urging in the wake of a new federal report on breast cancer screening.
Released Monday, the report has caused a stir with its recommendation that women in their 40s don't need annual mammograms and that self-exams no longer should be part of a doctor's instructions to female patients. Instead, the report suggests, women 40 to 49 who are not in a high-risk group should wait until 50 to begin mammograms and then have them every other year.
This is surprising news to women who for decades have been urged to spend part of their shower reviewing their breast tissue and submitting annually to the vise called a mammogram.
Meanwhile, the timing of the report in the midst of a health care reform debate about reducing medical costs has eyebrows raised. Under the proposed reform, the federal recommendations are to be used for setting standards for insurance coverage. Could the research be aimed at cutting costs at the expense of women's health? While some cancer groups, including the American Cancer Society, have objected strenuously to the panel's recommendations, Susan G. Komen for the Cure, the worldwide advocacy organization, is aiming for a more measured tone. It would be a mistake to overreact, says Eric Winer, Harvard oncologist and chief scientific adviser to the Komen group.
Instead, Nancy Brinker, Komen founder and the woman responsible for "pinking" the world, sees the report as yet another opportunity for activism. If current screening is imperfect, then make it better. After all, you don't get pink ribbons on running shoes and electric mixers by going negative. Thus, Brinker sees the federal report as a "clarion call" for researchers, government and funders to deliver a lower-cost, more effective screening tool. "We need 'tomorrow technology' and we need people to invest in it," she says.
The Komen group, which funds 1,900 education and screening programs around the world, isn't changing its recommendations for annual mammograms and self-exams for women 40 and older. It may not be a perfect protocol, but Komen's goal is more screening access, not less.
Still, both Brinker and Winer acknowledge that there's more agreement than disagreement with the findings of the report, issued by the U.S. Preventive Services Task Force. The problem is that "we've sought out the areas of controversy rather than the areas of consensus," says Winer.
Areas of agreement include: that mammograms do save lives in both younger and older women; that it is travesty that one-third of women in the world don't have access to screening; and that while imperfect, the mammogram is the best test.
Areas of controversy surround the when, whom and how often. As for breast exams, Winer says it's pretty widely accepted that teaching women to examine themselves is not more effective in detecting breast cancer than not teaching them.
Winer also says the panel's findings are based on analysis of several large and well-conducted studies and that different conclusions are probably a function of "murky data."
If Brinker has her way, the debate relaunched Monday will lead to improved technology so crucial to detection. If history is any guide, we may soon see new pink screening gizmos that are cheap, portable and accurate.
And the world will be calmer.
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