What Everyone Should Know About Mammograms
Does it make sense for all women over the age of 40 to get screened regularly?
A few years ago I felt a lump on the side of my left boob.
I didn’t wait. I called my doctor immediately who referred me for a mammogram. I was in my early thirties, healthy, and I knew of no history of breast cancer in my family. It’s probably something harmless, I told myself in the days before my appointment.
Thankfully it was. But it wasn’t that simple. After getting the mammogram I was sent to a waiting room where a nurse told me quietly that they wanted to perform an ultrasound to be completely sure of their conclusion. After the ultrasound, I was sent back to the same waiting room where a different nurse told me quietly that they wanted to perform a mammogram to be completely sure of their conclusion. Again?! I exclaimed. I felt like I was stuck in some kind of Kafkaesque dream. Being clad in nothing but a flimsy gown only made it feel even more that way.
Eventually we cleared up the confusion and I was told to get dressed and check out at reception. Only when I got to reception, I was told that I didn’t have the correct insurance: I'd be on the hook for thousands of dollars. Again, this was a mistake, and after a string of phone calls this one too, was cleared up. My final bill came to about $200. All-in-all, and factoring in waiting time, I’d been at the radiology center for about four and a half hours. Not cheap and a significant time commitment, but entirely tolerable as the price for peace of mind.
I walked out into the street cold, tired, hungry and almost late for school pick-up, but also so very grateful for medical technology and the knowledge that the lump wasn’t anything more sinister than dense breast tissue (Please google it…and read this piece about the risks associated with it published by The Cut).
I was reminded of this story last week as I read through an important study that’s just been published in the Annals of Internal Medicine which examines the choices women make on whether to get a mammogram or not, when presented with all of the pros and cons of being screened.
For context, the U.S. Preventive Services Task Force—a volunteer panel of national experts in disease prevention and evidence-based medicine—recently changed its recommendation for mammography screening: it now encourages all women to get a mammogram every other year after the age of 40. (The previous recommendation had been for women to only get screened regularly after turning 50.)
When I heard about that recommendation change, my instinct was to think of it as a good thing: more screening, equals earlier detection, equals fewer untimely deaths, right? Yes, but also, as ever, it’s not that simple. As it turns out, many women aren’t fully aware of the cost of getting routinely screened in their 40s. These can range from false-positive results, to unnecessary biopsies, anxiety and debilitating treatment for tumors that if left alone would do no harm, writes Ronnie Cohen for NPR.
But back to the study in question.
In it, 495 women aged between 39 and 49 were surveyed before and after they were presented with all of the potential advantages and disadvantages of having a mammogram. Before being given all of the information, only 8% said they wanted to wait until they turned 50 to get a mammogram. But after being given it, 18% said they would wait until 50. Crucially, the study found that learning about the downsides of mammograms did not discourage women from wanting to get screened at some point.
Almost half of the study participants indicated that they were surprised by the potential advantages and disadvantages. About a quarter said that the information about the risk of over-diagnosis which they had learned during the course of the study had not been conveyed to them by their doctor.
“We’re not being honest with people,” breast cancer surgeon Dr. Laura Esserman, director of the University of California, San Francisco Breast Care Center, who was not involved with the research, told NPR in an interview.
“I think most people are completely unaware of the risks associated with screening because we’ve had 30, 40 years of a public health messaging campaign: Go out and get your mammogram, and everything will be fine,” she said.
Esserman told NPR that she had encountered women who were diagnosed with “slow-growing tumors that she believes in all likelihood would never harm them.” And then there are also cases in which mammography can give women a false sense of security.
Cohen writes about the case of the 44-year-old actor Olivia Munn. “The 44-year-old actor had a clean mammogram and a negative test for cancer genes shortly before her doctor calculated her score for lifetime breast cancer risk, setting off an alarm that led to her being treated for fast-moving, aggressive breast cancer in both breasts,” Cohen writes.
Concerned about the repercussion of blanket recommendations for screening—and about the extent to which women in the U.S. are generally left in the dark when it comes to the upsides and downsides of getting a mammogram in their 40s—Esserman in 2016 decided to take action. She launched the WISDOM study designed to determine who needs to be screened when, who is most at risk and whether a more personalized approach to screening does, in fact, lead to better breast cancer outcomes than sweeping standard screening guidelines.
“We want to test smarter, not test more,” she said, in an article about it published on the University of California’s website. “Over the last 30 years, we’ve learned that breast cancer is not just one disease. We’ve also learned that women’s risks for developing each type of breast cancer varies.”
She adds that, “when it comes to breast screening, one size may not fit all.” It’s known, for example, that Black women have more aggressive cancers and higher mortality rates from cancer than others. “Reducing health disparities is part of our mission so that someday all women can live longer, healthier lives,” said Esserman.
As of February last year, the WISDOM study had enrolled more than 50,000 participants across the country. Of those, more than 20,000 women had learned about their genetic risk for breast cancer, 1,500 women had learned that they are at elevated risk and more than 300 women had been treated for cancer. Researchers found that those numbers indicate that the majority of women are indeed at low risk and may not need screening until they are in their 50s. For a minority of women, however, early screening is really important.
There is no part of me that regrets getting a mammogram after discovering a lump when I was just 33. I’d hope you would have done the same, and the numbers are unsettling: According to the National Cancer Institute more than 300,000 women are likely to be diagnosed with breast cancer this year, of which 42,250 will likely die. Approximately 13.1 percent of women will be diagnosed with breast cancer at some point during their lifetime.
But I also believe strongly that a healthcare system that gives women the power, tools and information to make her own choices and decisions about care is far more efficient than one that treats us like a monolithic demographic.
You can read the full study that came out last week here. Here’s a link to last year’s University of California article about the WISDOM study.
Vance for VP
Elsewhere last week, I joined everyone else in America in digesting the news that former President Donald Trump had chosen as his running mate in the November election JD Vance, a senator from Ohio, who has fiercely and publicly opposed abortion rights and some LGBTQ+ rights.
But the thing about Vance is also that he’s complicated. The 19th* did an excellent job of delving into his politics and personality. Here’s an excerpt from political reporter Grace Panetta:
Vance, who ran as staunchly anti-abortion in his Senate campaign and in 2021 compared abortion to slavery, has somewhat shifted his public stance on the issue. Trump has reportedly viewed a hardline stance on abortion as a negative for a running mate.
On the campaign trail in 2021, Vance defended the lack of exceptions for rape and incest in a Texas abortion ban known as S.B. 8, saying in an interview that “two wrongs don’t make a right.”
“It’s not whether a woman should be forced to bring a child to term, it’s whether a child should be allowed to live, even though the circumstances of that child’s birth are somehow inconvenient or a problem to the society,” he said
In a 2022 Senate debate, however, Vance said he supported “reasonable exceptions” to abortion bans. He was still broadly against access, however, saying he would be “totally fine” with a “minimum national standard” on abortion laws.
I’d also recommend this useful and thorough explainer by the Associated Press and finally, this Substack post by Trump’s estranged niece, Mary L. Trump.
She writes:
Donald was never going to pick a woman to be his running mate. He has far too much contempt for us.” And adds: “In Vance, he’s found someone who hates women as much as he does; someone who wants to control them as much as he does. If the Trump/Vance ticket wins this election, it will be the beginning of the end of women’s reproductive rights and bodily autonomy.
Women in the Services Industry
Finally last week, I came across interesting research showing that a growing number of women around the world are working in the services sector. It might sound a bit wonky but here’s why that’s important:
The services sector includes everything from communications and transport to finance, education and tourism. It generates more than two-thirds of global GDP and employs more workers than any other sector.
Because of all of that, the World Trade Organization describes the services sector as “the backbone of the world economy”. And therefore it’s a key source of female empowerment.
The research, co-published by the WTO and the World Bank, found that in 2021, 59% of employed women globally worked in the sector, up from 44% in 2000. On the other hand, services accounted for 45% of total male employment in 2021.
The report concluded that the share of women working in services has increased “across all economies, with the biggest rises in upper-middle-income (22 percentage points) and lower-middle-income (14 percentage points) economies.”
The data is worth digging into, especially considering the economic participation gap is still one of the most significant gender gaps around the world.
As always, a last shameless request. If you’ve read WOMEN MONEY POWER, book, or listened to the audiobook, I would hugely appreciate it if you could take just thirty seconds to post a review or rate it on Amazon using this link. If Goodreads is your jam, that’s just as great, and you can leave a review or rating here. Thank you so much for your support!
Over the summer I’ll be taking a few weeks off here a there, mostly to accommodate fewer childcare hours and a tired brain. I won’t be publishing next Monday, July 29. But I’ll be back in your inboxes August 5.
Be safe and happy holidays to those celebrating,
Josie
