The current administration came to office on a platform promising greater transparency in the workings of government, a pledge Americans eagerly embraced. Transparency – the ability to see and understand the factors leading to decisions – is certainly something we can all endorse (especially those of us who make our living providing information to the public).
That is one of the reasons the new breast cancer screening guidelines from the U.S. Preventive Services Task Force are so troubling. Even given the fact that they are only recommendations, with no binding power, the thinking behind them gives one pause. In particular, the suggestion that women should not be taught the technique of breast self-examination raises an important question: Why not? Why should women not know everything there is to know about themselves and their bodies?
This is an issue of great importance to the Jewish community, since women of Ashkenazic descent are among those at high risk for carrying the BRCA1 and BRCA2 genes, known to be associated with breast cancer.
Self-exam, say its supporters, is quick, free, and available to all women, even those who don’t have easy (or any) access to primary care doctors. In addition, it gives women a feeling of empowerment, a sense that they are taking charge of their own health.
Granted, there are good arguments on the other side as well, borne out by recent studies contending that such exams increase the likelihood of women’s finding harmless lumps, putting them at risk for unnecessarywww.chicagotribune.com/topic/health/medical-specialization/biopsy-HEPAS000023.topic, treatment, and psychological stress.
Even the American Cancer Society, which has not wholeheartedly accepted the new guidelines, regards self-examination as optional. Similarly, Susan G. Komen for the Cure – which continues to recommend routine mammograms for women 40 and up, unlike the new guidelines – has not been advocating self-exams but has been stressing that women should be “aware” of their breasts (size, shape, color, etc.).
Still, even if the new recommendation makes statistical sense, even if it is true that women who have done self-exams have had twice as many biopsies with benign results as women who didn’t examine themselves, there are cases where self-examination has saved women’s lives.
Health-care dollars are scarce, but partly as a result of greed, mismanagement, and waste. To put the burden of the cost overrun on the thousands of women who might just detect their own cancer hardly seems fair.