Breast cancer detected other ways

Dear Editor,

Scientists released a report suggesting mammograms are necessary only after the age of 50. The public uproar has been deafening.

As one of my favorite sayings goes – one no doubt favored by youth everywhere – “the leading cause of death in America is life.” That is we aren’t happy to admit it, each of us knows we will die. We cannot know when or how it will happen. All we can do is play the odds – health care is really just a bunch of tricks to tilt the table in our favor – and hope for the best.
Take smoking for example, a universally accepted bad habit and guaranteed death sentence. Smoking increases the chances of certain illness, all of which shorten lifespan, but whether and how much a particular ailment will affect a particular smoker is unknown.

The bottom line is that smoking is bad for you. If you look at enough smokers over a long enough period of time, the vast majority will die before they should. So the government tries to get people to stop and we don’t object to the millions in taxes spent to broadcast this message. Faced with such overwhelming scientific evidence, how could we?
Compare this to the Nov. 16 mammogram report. Contrary to the enemies of health care reform, the report’s authors do not set government policy. Even if they did, the private companies that control your health care can (at least for now) decide whether or not to follow the recommendations.

The scientists researching mammograms no doubt designed their study to answer the same question as the smoking researchers: How can Americans live the longest and healthiest lives?

Yet the outrage over new mammogram recommendations has been enormous and the coincidence of the proposed health care reforms don’t help. But Americans would speak out even in the absence of such reforms.

The reality is the American health care system was designed like the rest of our economy: to create consumption.

Not surprisingly, we have grown accustomed to the idea of health care as doctor visits, procedures and pills. Those who recommend reductions in this mainstream conception of health care, as we’ve seen, are met with skepticism and outright hostility. We’ve forgotten that the vast majority of health care is how we live our daily lives: what foods we eat, how much we exercise, how well we sleep and the quality of our relationships. These have a greater aggregate impact than trips to the hospital, MRIs, prescriptions and other medical interventions.

The controversy about the news mammogram report highlights America’s obsession with treatment, particularly the widespread belief that we are entitled to what we think we need. When it comes to health care, we give in to our fears rather than putting our faith in science.

These fears are normal. Who wants to get sick or die young? But look what happens when we trust the scientists: Despite decades of resistance from the tobacco industry, science was finally able to convince America of the harms of smoking. Our nation is healthier as a result. Can we make a similar leap of faith here?

Which leads me to the irrational intersection between smokers and under-50 mammogram advocates: Each sincerely believes that they’re going to beat the odds. The smoker thinks he’s going to be the 90-year-old Marlboro Man, when the statistical reality is each puff deducts minutes from his life. The under-50 mammogram advocate knows early detection will save her life, when the statistical reality are symptoms or other detection methods are more likely to reveal the cancer.

I have a relative who was recently diagnosed with breast cancer. She received annual mammograms, but the most tragic aspect of her case is that after diagnosis the doctor reviewed the previous year’s mammogram only to find the same lump in her breast.

“They should have caught it last year,” the doctor told my relative. But they didn’t. Despite her habit of annual mammograms, the cancer had an extra year to wreak havoc. Luckily my relative’s prognosis is great. Her tenacity will help her to overcome this obstacle as it has overcome all the others life has thrown at her.

So smoke ‘em if you got ‘em (or don’t). Skip mammograms in your 40s (or don’t). Whatever you decide, rejoice in each day’s roll of the dice. Because you never know when those snake eyes are coming.

Mike Keefe
Law 2010