The XX Factor

Why Conservatives Aren’t Wrong to Question Breast Cancer Screenings

Washington, UNITED STATES: The pink ribbon, symbolic of breast cancer support, is seen during the Komen Community Challenge rally 26 April, 2007 on Capitol Hill in Washington, DC. The Susan G. Komen for the Cure released the ‘Breast Cancer Mortality Report: Closing the Gaps in Eight Communities,’ which gives an in depth look into eight communities with unusually high breast cancer mortality rates. AFP PHOTO/Karen BLEIER (Photo credit should read KAREN BLEIER/AFP/Getty Images)

Photo by KAREN BLEIER/AFP/Getty Images

Last week the Daily Kos did a poll which showed that 51 percent of conservatives have an unfavorable view of Planned Parenthood’s breast cancer screening services. In a post about the poll, Kos writer Kaili Joy Gray commented, “Guess the sanctity of their political opposition to women’s health care trumps the ‘sanctity of life.’” Jezebel followed suit over the weekend, criticizing conservatives who don’t look kindly on Planned Parenthood’s screening services as embracing “a pro-cancer platform.” While it’s entirely possible that the conservatives with an unfavorable view of PP’s breast cancer screenings just hate everything the organization does and that they don’t give a fig about poor women’s health, what’s been lost in the Susan G. Komen fracas is that screening mammograms might not actually be the panacea that Komen has made them out to be.

Slate contributor Christie Aschwanden has a thorough, wonderful post about breast cancer science on Discover Magazine’s website. She describes the common breast cancer narrative that Komen has been peddling—“that breast cancer is a uniformly progressive disease that starts small and only grows and spreads if you don’t stop it in time”—as deliberately misleading. Aschwanden explains the way breast cancer works:

Years of research have led scientists to discover that breast tumors are not all alike. Some are fast moving and aggressive, others are never fated to metastasize. The problem is that right now we don’t have a surefire way to predict in advance whether a cancer will spread or how aggressive it might become. (Scientists are working on the problem though.)

Some breast cancers will never become invasive and don’t need treatment. These are the ones most apt to be found on a screening mammogram, and they’re the ones that make people such devoted advocates of mammography. H. Gilbert Welch of the Dartmouth Institute for Health Policy and Clinical Practice, calls this the overdiagnosis paradox. Overdiagnosis is what happens when a mammogram finds an indolent cancer. A healthy person whose life was never threatened by breast cancer is suddenly turned into a cancer survivor. She thinks the mammogram saved her life, and so she becomes an advocate of the test.

Some cancers behave just the opposite of these slow-growing, indolent ones. Researchers now know that some cancers are extremely aggressive from the start. There’s simply no such thing as “early” detection for these cancers. By the time they’re detectable by any of our existing methods, they’ve already metastasized.

Aschwanden makes clear that she’s talking about screening mammograms here—which are mammograms given to healthy women in which tumors might be found. That’s different from a diagnostic mammogram, which is done after a woman has already detected a lump in her breast.

Planned Parenthood may have been using Komen’s money to fund both screening and diagnostic mammograms and the referrals of these services. I’ve yet to see any information from either organization that distinguishes the two. The only hope here is that the publicity surrounding this kerfuffle will result in scrutiny of how breast cancer charity money is being used. Assuming people who don’t automatically support screening mammograms are “pro-cancer” would be part of that.