A little context, please.
In the 2012 presidential campaign Barack Obama torched his opponent for suggesting that the government should stop funding Planned Parenthood.
When Governor Romney says that we should eliminate funding for Planned Parenthood, there are millions of women all across the country who rely on Planned Parenthood for not just contraceptive care. They rely on it for mammograms, for cervical cancer screenings.
Some media outlets quickly pointed out that Planned Parenthood does not perform mammograms. It refers women to outside providers.
Still, the damage was done. As always, Romney failed to respond with sufficient vigor and the meme contributed to the concept that Republicans were trying to compromise women’s health.
A recent study from Canada, however, has shown that yearly mammograms are not necessarily such a good thing.
Cancer surgeon Marty Makary writes in Time:
A recent study found that yearly mammograms do not prolong the lives of low-risk women between the ages of 40 and 59. Following 89,000 women for 25 years in a randomized controlled trial (the gold standard of science), the study is as methodologically impressive as they come. In fact, in research terms, the report has more scientific merit than any medical study of chemotherapy. As hard as it is for our pro-screening culture to believe, the data are clear. We are taxing far too many women not only with needless and sometimes humiliating x-rays, but also with unnecessary follow-up surgery.
It is worth noting that many of the extra tests and procedures are anything but benign. And, we emphasize that the Canadian study recommended that women do regular self-examinations.
Makary also underscored another important point. As a nation we screen too much for disease:
New research is finding that some health screening efforts have gone too far.
The annual mammogram is not the only vintage medical recommendation under scrutiny recently. Another large study found that among low-risk adults, a daily aspirin — a recommendation hammered into me in medical school — kills as many people from bleeding as it saves from cardiac death. Doctors are also re-evaluating calls for regular prostate-specific antigen (PSA) tests and surgical colposcopies after “borderline” Pap smears because of the risks of chasing false positives and indolent disease.
In his article, Makary was re-evaluating his own approach to cancer. Being a cancer surgeon, and having seen many people from the disease, he wants to do everything possible to prevent the disease, or better, to stop it before it becomes incurable.
Yet, our culture has cast him, like other physicians, as an armed combatant in the war against cancer:
As a surgeon, I’m trained to crush cancer. For many years, every tumor I palpated and family I counseled drove me to hunt for cancer with vengeance, using every tool modern medicine has to offer.
Who could possibly argue with that?
And yet, in their zeal to do battle with the great killer, physicians mistook good intentions for good results. Imagining that they were doing God’s work they failed to evaluate the outcomes of the tests objectively.
Makary explains how he discovered this:
The patient’s story began with a full-body CAT scan, a screening test used to detect tumors, which revealed a cyst on his pancreas. Some 3 percent of humans have these cysts and they are rarely problematic. Based on his cyst’s size and features, there was no clear answer as to what to do about it, but he was given options.
The patient tossed and turned every night, agonizing over stories of pancreas cancer tragedies, consumed by the dilemma of whether to risk surgery to remove the cyst or leave it alone. The conundrum strained his marriage and distracted him from his work.
Months before I met him, the patient underwent the surgery, which revealed that the cyst was of no threat to his health. The operation was supposed to cost $25,000 and eight weeks out of work. But the toll was much greater, including a debilitating surgical complication.
I thought: this is why he shouldn’t have had a CAT scan in the first place. Screening made him sick.
In truth, information about the risks of overtesting and performing unnecessary procedures has been around for a while now. I have reported on it here.