This week there has been a raging war of words around the US Preventive Services Task Force recommendations for screening around two women’s health care issues. Well, in the US, anyway. Mammograms and Pap tests (smears).



The mammography guidelines have stirred up a lot of fear, accusations, confusion, political posturing, and backtracking, among many other things. Bubbling up for moments are reasonable conversations about the science and the guidelines.



I am a huge advocate of screening and early detection. Like most providers, I have seen cancer in young people, AND in people not considered high risk. I have also seen people in high risk categories of a disease, who never get the disease. Screening is an important tool in health care.



With that said, I think it is important to remember that these are “recommendations”.
I also want to remind people that the CDC and other organizations have relied on the advice of the US Preventive Services Task Force to set standards because of the excellent, thorough and unbiased work they do. Much of Europe has been using these guidelines for years based on a meta analysis of many research projects over decades from around the world.. And on the global health scale, these countries have a much stronger record of health than the US, which consistently is in the bottom for most health indicators except expenditures.



So, bottom line is to look at screening both individually and societal. There are costs…not just monetary, but other costs. There are unnecessary treatments and surgeries



We know screening mammograms can detect early stage breast cancer, but when do we start….at 40? 35? 30? 20? What about for men, who tend to find out later, and for whom the cancer is deadlier? How do we decide? This is what this task force is providing us information about. The recommendations are not “deciding whether you should ever screen a 40 year old”, but “when” and “how often”. Not blindly follow the guidelines, but evaluate and make the best educated guesses about early detection.



Now let’s take a big breath.



My recommendations are – Go over your family history, personal history, lifestyle and toxin exposures. BRACA gene? (Those at higher risk need to start earlier and potentially with an MRI) Look at geographically where you live, and whether cancer rates are higher. Your ethnic background makes a difference in terms of cancer risk as well. Physical exams and present health concerns. Look at the statistics and incidences. THEN make a decision. Not out of fear, but out of empowerment and knowledge. And don’t forget about intuition. Intuition is a powerful tool. This is often mistaken for fear, but if you have a gut feeling or are worried, by all means talk with your doctor and get a mammogram.



Also, it is important to remind ourselves of the reality that none of us knows everything and that even tests are not 100%. In this country we are looking for perfection and absolutes. But in reality, there are none. Weigh the factors….the pros and cons. And then make a decision that is right for you. Don’t judge others for their decisions. Re-evaluate often. The research and you change all the time.



You are in control of your health. Make the choices that make the most sense for YOU.



Here’s a recent article that I found interesting from the New York Times.