Value of breast cancer screenings told in lives

Dangerous. That’s the word Lead Radiologist at The Rose, Dr. Mahdieh Parizi, uses to describe the United States Preventive Services Task Force recommendations that seriously threaten preventive health care for women. The task force, an independent panel of health experts whose recommendations influence the decisions of health care providers, insurance companies and policy makers, has declared that annual mammograms should no longer be recommended for women in their 40s and that women from age 50 to 74 should only have one every other year. These recommendations defy 30 years of history, which has proven over and over again that annual mammography decreases deaths from breast cancer.

Dr. Parizi has looked at thousands of mammograms. She’s seen the tiny specks that lie waiting to claim another life, cancers too small to be felt. She’s seen the pathology that predicts the length of life and the intensity of treatment. She’s sat across the table from hundreds of 40-year old women — anxious women — waiting to hear the results. She’s struggled to find a gentler way to say the words, “You have breast cancer.”

For some, she can add: “We caught it at an early stage. That’s the good news.”

But if the task force recommendations are implemented, that sentence won’t be heard often. The recommendations disregard studies that clearly show that a twoyear delay in mammograms almost guarantees any breast cancer found will be at a later stage and more difficult to treat and survive.

And they discount the task force’s own acknowledgement that mammograms are a valuable and vital life-saving tool for women.

If the recommendations are allowed to be implemented, insurance companies and health plans will no longer cover screening mammograms for women in their 40s. Many doctors will no longer recommend annual mammograms and will no longer have a reason to see a patient every year. This will be another time the physician will be caught between reimbursement issues, “national” recommendations and doing what he/she knows to be right. Women will question the value of the screening based on this “expert” guidance. In short, women will stop screening. Women will die who might have otherwise beaten this awful disease if it had been detected early.

Lots of articles have been written in opposition to the recommendations. The articles question the validity of the studies that were used in compiling the statistical value of mammography in younger women.

A key question: Why did the task force not include a single breast specialist? Many debunked the concept that “recalls” — secondary mammograms done for additional assessment — create undue anxiety in women. Other articles questioned why the benefits of mammography weren’t included in the equations.

No one argues that we diagnose fewer women in their 40s than in their 50s and 60s. The statistics are clear. But the women we diagnose at The Rose are not statistics. The 150 women under the age of 50 who we diagnosed last year are not statistics. They are mothers, daughters, sisters — women who love and are loved, and who are important to their families. The women who sit across that table from Dr. Parizi are flesh and blood — with a full life ahead of them. Maybe.

In December 2015, Congress passed the Protecting Access to Lifesaving Screenings Act. This placed a two-year moratorium on implementing the task force’s deadly recommendations. The law requires that new reviews be performed, hopefully using the most current technology: digital imaging — the gold standard now in mammography. And during this two-year period, insurance companies must continue to cover annual mammograms for all women ages 40 through 75. Thank goodness.

But two years will go by in the blink of an eye.

At The Rose, our mission has always been to reduce deaths from breast cancer by ensuring women have access to screening, diagnostics and treatment services. The task force recommendations seriously threaten that access. They are, to use Dr. Parizi’s term, dangerous. Their implementation will result in more women dying. Therefore, we have created a task force of our own to challenge these recommendations in the only way we know how — gathering people to help, telling the stories of young women who are diagnosed, relying on the expertise of medical professionals in women’s breast health care, and creating a signature campaign to carry to Congress to ensure women continue to have access to life-saving screenings.

We have seen first-hand the consequences when women do not have access to care. One study predicts 100,000 women will lose their lives if these recommendations are implemented. Too many lives will be lost; too many women will need more aggressive treatment for later stage cancers; too many families will suffer unnecessarily if we don’t stop the implementation of these recommendations.

Sure, ours is a grassroots effort. Sure, it’s a daunting task. We’ve beaten the odds before. With help, we will again.