The XX Factor: What women really think.

Stefanie Spielman, RIP

Know More, Screen Less

Emily B, I agree with you that it’s really unfortunate that the conclusion that we don’t need to routinely do mammograms until 50, instead of aparking a national, rational discussion about the advisability of “screening and prevention,” has become the harbinger that we’re all going to live under British health care rationing. The debate over whether we benefit from searching for early cancers is not new, and no wonder the public is so confused. This is like the “no fat” to “no carbs” pendulum swings on official diet recommendation ... (Read the rest of this article in DoubleX.)

The Mammogram Mania

I've been trying to understand the flap this week over the recommendations from the U.S. Preventive Task Force—a group ill-prepared to handle the controversy—to delay routine mammograms to age 50 for most women. And now, in a truly terrible coincidence of timing, we have a second round of commotion over the advice of the American College of Obstetricians and Gynecologists to push pap smears to screen for cervical cancer back to age 21 ... (Read the rest of this article in DoubleX.)

Women Need a Pap Smear for Breast Cancer

A guest post from Cindy Pearson, the executive director of the National Women's Health Network:

Mammography screening just doesn’t work very well in women before menopause, as the U.S. Preventive Services Task Force has now recognized. Everyone hoped that it would. But in 1993, it became clear from well-done studies that our hopes hadn’t panned out, and screening just didn’t work well for women in their 40s (or at all, for even younger women). The fact that most women didn’t know this, and instead received a falsely optimistic message about the life-saving benefits of once-a-year mammography screening, was incredibly frustrating. More background here.

At the National Women’s Health Network, we’re glad that the federally appointed task force has told the truth about what studies have found. Now women have a better chance of getting an honest assessment about the value of a heavily promoted technology. Information is always a good thing ... (Read the rest of this article in DoubleX.)

The New Mammogram Guidelines Smell Like Rationing

We keep hearing from proponents of health care reform that government rationing of health care is a “canard.” We don’t have health care reform yet, but with the new recommendations from the U.S. Preventive Services Task Force that women shouldn’t get mammograms until the age of 50, and then only every two years, it feels like we’re getting the rationing.

The Los Angeles Times writes that “[i]nsurance companies and Medicare administrators … said they they would continue to pay for the procedure -- although it is not clear how long they can resist the panel's influence.” The LAT adds that the panel’s recommendations are “generally followed” by insurers and Medicare ... (Read the rest of this article in DoubleX.)

Would You Take a Pill That Prevents Cancer? Unlikely.

Gina Kolata points out, once again, that diet and exercise have not been shown to affect breast cancer rates. Massive, well-run observational studies and randomized controlled trials turn up nothing. This finding appears to be unacceptable; popular culture rejects it utterly. Women’s magazines continue to preach the holy gospel of five fruits and vegetables a day. Doctors continue to tell patients at high risk of breast cancer that diet matters. The director of one of the (fruitless?) studies tells Kolata that doctors need to “rethink the studies.” Diet and exercise “are likely quite important, but we just aren’t getting the answers” ... (Read the rest of this article in DoubleX.)

Just Say No to Mammograms?

John Edwards' Third Act

Melinda, I don't mean to sound calloused and insensitive on top of my stated willingness to invade personal privacy, but, notwithstanding how plucky and determined she is, Elizabeth Edwards has inoperable metastasized cancer. Cancer grows, that's its job (though, to be sure, effective treatment can slow it way down and seems to be doing so for Edwards). Of course, one hopes for a miraculous survivor story, but a practical conversation about the other woman who might someday be raising her children is, though unimaginably difficult, not inappropriate.

I had breast cancer in 1995 and share Melinda's post-surgical hopefulness. If I'd had a less positive outlook, however, I would certainly have wanted my husband to remarry someone who could be a mother to my then-minor child. (I would, however, expect him to sequence the two events more traditionally than John Edwards has.) Now that Edwards must, as Emily Y. points out, inevitably exit political life, the next order of business should be the welfare of all his young children.

Adventures in Plastic Surgery

(Disclaimer: As I explained to the judge who wanted to seat me on a med-mal jury, I am the sort of person who took one look at the plaintiff and barely managed not to yell, "You go, girl!'' Some practitioners may think they are God, but the distinction is not lost on me. I'll skip the tick-tock on how this became so clear, other than to reiterate that you should always, always—no matter how dismissive your doctor is—always biopsy a palpable lump. And if they later go to the opposite extreme and tell you you're dying? You might not be.)

My problem with the whole plastic surgery industry, in any case, is that it's focused on cosmetic enhancements to the detriment of patients in need of upgrades that are not quite so elective. I learned this a little over a year after my initial cancer diagnosis, when I again had to insist on having some new breast changes biopsied. Just before they wheeled me into surgery, my doctor half-jokingly complained to my husband that I was an awfully interactive patient: "Your wife has been reading again,'' he told him. They found only pre-cancer that time, but the safest course was still a mastectomy, and the reconstruction was going to be more complicated because I'd already had radiation. So now, I had to navigate a whole new corner of the medical world, where health concerns often seemed beside the point.

The first plastic surgeon my doctor referred me to was a highly regarded guy whose waiting room was filled with black marble and nurses who greeted me by name, in a whisper. I knew going in that he did mostly elective work, because even before my visit, I'd been sent literature describing the full array of available services. (A little eye job, perhaps, with my mastectomy?) Still, I was floored by how little he seemed to understand about my options, because implants under radiated skin are iffy. When I asked about the possibility of transplanting abdominal tissue, he said I wasn't a candidate for that procedure because I didn't have enough padding to spare. (And no, sadly, bulking up like Renee Zellweger for her role in Bridget Jones would not have worked; those fat cells are smart little buggers.) To underscore his point, he reached over and pinched my belly. "Do you want a breast that looks like this?'' Uh, not really, I said. But could what I wanted have been any more irrelevant? While mentally strangling him with the jaunty little golf tie he was wearing, I asked if he had ever operated on anyone in my situation. Surely he had, he said, but he couldn't really remember.

Next, I sought the advice of two top surgeons at a teaching hospital, who do the procedure I "wanted,''  a procedure known as the free flap. They said I could expect to lose maybe a third of my abdominal strength after they cut into my rectus muscle. "But you don't look like a rock climber to me,'' one of them added cheerfully, so I'd hardly notice. I wasn't so sure. Doesn't abdominal muscle support the back? And come in handy for exotic pursuits like hoisting groceries and children, or throwing a suitcase into the overhead bin? How about that new muscle-sparing version of the procedure I'd been reading about? Not an option, they said.

In frustration, I hauled out my well-worn copy of Dr. Susan Love's Breast Book, and found her reference to a doctor at UCLA who had done some pioneering work with the free flap. Though he had since retired, I located a young doctor who had trained with him and regularly performs a muscle-sparing version of the free flap, the deep interior epigastric perforator (DIEP) flap. And he had the answers I'd been looking for: "There's never any reason to take the abdominal muscle,'' he told me, "except to add volume to the breast.'' (How much is enough? Shouldn't that, if nothing else, be left up to us?) Finally, I asked him why the DIEP flap was not more widely available. "To be honest? Because it's hard to do and it takes all day. You could do two facelifts and be on the golf course'' in half the time, with twice the profit.

But vanity, too, can survive cancer. As I left his office after my first post-op follow-up, he dashed through the waiting room after me, and right there in front of Jesus and half of Santa Monica said he had some Botox left over at the end of the day, and would I like to try some at no extra cost? I love this guy, so not all doctors deserve the booby prize, so to speak. And you gotta, gotta, gotta love L.A.

Titties, Beer, and Breast Cancer

Today's the last day of Breast Cancer Awareness Month and some bloggers are arguing that the ubiquitous "pink-ribbon" approach has gone too far. (See the second panel.) Over at The Assertive Cancer Patient you can find a critique of the relentless "awareness" approach: Sather is giving out awards to readers who nominated the tackiest and most trivial products sold in the name of breast-cancer. The prime offender?

Grand Prize: to the blogger Dubutant, for her entry: Jingle Jugs for Life

Jingle Jugs sells life-size boobs, or "racks," that bounce in time to the song "Titties and Beer." Its market? Frat boys.

From the Jingle Jugs Web site: "Our newest version of Jingle Jugs comes with a pre-recorded breast cancer message. A second re-recordable chip allows the user to record a message of his or her own choice, such as a favorite song, your favorite team's fight song, a romantic message, a political commentary . . . all to which the Jugs will dance and move in synch." (http://www.jinglejugsforlife.com/)

Debutaunt's comment, in a letter to Komen: "... Honestly, I can't see in any good conscience how you can justify accepting money from this vulgar company. They sell a product that is so putrid and heinous, but are justifying it since they donate a ‘percentage' to breast cancer organizations -- then show proudly their giant check to Komen."

Now, the original Jingle Jugs product sounds totally ridiculous, and this "Jugs Across America" tour is juvenile at best. (Traveling Breast Museum? Please.) But the vilification of the company's breast cancer product raises some questions in my mind: Is it really all that bad for the makers of this yucky product to preach a philanthropic message to their customers, however self-serving it may be? Is this product purely a shameless attempt to win some easy PC-points? Or is it indicative of the fact that we now live in a hard-headed post-feminist age where we accept that the objectification of women will always exist, but ensure that at least now people who buy gag items like this know (or are reminded) that women aren't just objects, they're people who can get sick too? I lean toward thinking the latter. But I can imagine that if I had breast cancer I'd be grossed out.

Check out Sather's write-up of the worst pink-ribbon products here.