Starting today through Jan. 27, the Trust Women/Silver Ribbon Campaign and MoveOn are collaborating with more than 50 organizations, including Our Bodies Ourselves, in holding an online virtual march to let legislators know that reproductive health, reproductive justice and reproductive rights are at the top of our agenda, and should be at the top of theirs.

Why the massive collaborative push now? As eloquently explained by Ellen Shaffer of the Center for Policy Analysis:

In 2011, a record numbers of bills were introduced or passed by state legislatures and the U.S. House of representatives restricting women’s access to: basic health care services, family planning, and safe abortion care. It has been called a “War on Women,” Many women are shocked and dismayed by these attacks and want to send a strong message to policy-makers: Government should stay out of making decisions about what happens in my womb. I have self-determination, autonomy.

The Guttmacher Institute has more detailed coverage of the abortion restrictions enacted in 2011, noting that legislators across the country “introduced more than 1,100 reproductive health and rights-related provisions, a sharp increase from the 950 introduced in 2010. By year’s end, 135 of these provisions had been enacted in 36 states, an increase from the 89 enacted in 2010 and the 77 enacted in 2009.”

If you, too, have had enough, add your name and location to a map, along with one of six messages like, “I Trust Women and I Vote,” “Reproductive Rights are Human Rights,” and “Contraception is Prevention.” If you watch the map, new names pop up in real time as more people sign on.

The next steps of this national action, as explained by Our Silver Blog, involve sending messages from virtual marchers directly to members of Congress, governors and state legislators “to underscore that Americans trust women to make their own decisions about their bodies and their lives.”

Please join all of us concerned about women’s health and rights by signing on to the march, and sharing info about the event with your friends via Facebook and Twitter.

Breast Cancer Action is hosting free one-hour webinars on Tuesday, January 24th and Wednesday, January 25th to discuss the recent Institute of Medicine report on environmental risks for breast cancer, including how advocates can help move forward the report committee’s recommendations for better understanding and managing these risks.

BCA will discuss some of their concerns about the report, as well as focus policy changes required to reduce exposures to potentially cancer-causing agents.

The report, commissioned by Komen, explores the difficulties of studying how environmental factors affect breast cancer risk, recommends future research, and makes recommendations for steps women can take to reduce their breast cancer risk. Unfortunately, many of the clear actions provided in the report for reducing risk are well-covered things like “quit smoking,” while the strongest conclusion that could be drawn on many other exposures (like cosmetic and personal care products, plastics and other pollutants) was that more research was needed.

If you’re interested, you can register for register for 2pm-3pm (PST) on the 24th or 10am-11am (PST) on the 25th.

Last week we posted about the Trust Women/Silver Ribbon campaign banners placed around Market Street in San Francisco carrying messages like “Reproductive Rights are Human Rights” and “Her Decision, Her Health.”

Today, the Huffington Post reports that the banners have drawn attacks from the anti-choice Life Legal Defense Foundation, which has threatened to sue the city for allowing the banner poles to be used to promote a political message not related to a specific event.

In response, Department of Public Works Spokeswoman Gloria Chan:

…defended her agency’s decision to allow the Center for Policy Analysis to buy space on the poles, saying that the banners are running in conjunction with two events: the Walk for Trust Women scheduled to take place on Market Street on January 20th and the The Bay Area Coalition For Reproductive Rights’ West Coast Rally For Reproductive Justice slated for Justin Herman Plaza the following day. Chan noted that any event expected to draw over 500 people, which DPW officials expect both of these to do easily, qualifies as a “city-wide special event” and is permitted to have its ads posted.

For more on the banners, including links to pictures, see our previous post.

A reminder: an online Virtual March will be held with MoveOn during Trust Women Week, January 20-27, to express support for reproductive health, rights, and justice, and to send pro-choice messages to Washington. Look for more details on the Our Silver Ribbon blog.

Our Bodies Ourselves is one of 42 partners in the Trust Women/Silver Ribbon campaign, a project to increase the visibility of pro-choice messages.

Our Bodies Ourselves is one of 42 partners in the Trust Women/Silver Ribbon campaign, a project to increase the visibility of pro-choice messages.

This week, the campaign has placed banners along Market Street in San Francisco to “spark conversations and to help build momentum and solidarity among supporters of women’s rights, equality and autonomy and access to comprehensive health care, including reproductive health care services.”

The banners display messages like “Reproductive Rights are Human Rights,” “Her Decision, Her Health,” and “U.S. Out of My Uterus,” and include related banners from the Bay Area Coalition for Our Reproductive Rights, SisterSong/Trust Black Women, Catholics for Choice, NARAL-ProChoice California, and Planned Parenthood Shasta Pacific. More photos of the banners in place around San Francisco are online, and more coverage is provided at Our Silver Blog.

Look for more activity later this month – during Trust Women Week, January 20-27, a virtual march will be held with MoveOn to express support for reproductive health, rights, and justice, and to send pro-choice messages to Washington.

The U.S. Food and Drug Administration (FDA) is seeking public comment on a draft guidance intended to define expectations about inclusion of women* in medical device research, including making sure women are represented in clinical trials and that data on women’s outcomes with devices should be collected and reported. Medical devices include products like contact lenses, coronary stents and pacemakers, breast and hip implants, prostheses, and other equipment for diagnosis and therapy.

The FDA is the agency that approves medical devices for use/marketing in the United States, so we would expect them to ask about these issues and data when companies propose that a device be approved.

This is meant to improve how risks and benefits of medical devices can be understood and communicated to women, and to encourage researchers to consider how sex-related differences may affect women’s outcomes when using medical devices.

For example, according to an evaluation of studies used to seek approval for heart-related devices, there was “persistent underrepresentation” of women – only about 1/3 of the study participants were women. Studies of certain existing heart devices have already found increased risks of adverse effects in women for some products, and possible better outcomes for women using some other devices.

Comments are due before midnight (Eastern time) on March 12, 2012. They can be submitted online, or via mail to the Division of Dockets Management (HFA-305), Food and Drug Administration, 5630 Fishers Lane, Rm. 1061, Rockville, MD 20852. If you write a paper letter, you should include the docket number: FDA-2011-D-0817.

*Note: the language used in the FDA documents defines female sex “according to their reproductive organs and functions assigned by chromosomal complement,” and gender as provided by patient/participant self-report.

You may have seen recent news coverage along the lines of “BRCA variants not tied to worse cancer outcomes.” This story refers to a recently published study about changes in the BRCA1 and BRCA2 genes that affect breast and ovarian cancer. Women with mutated versions of the genes have greater risks of breast and ovarian cancer than women with typical versions of the genes.

In the new study in the Journal of Clinical Oncology, researchers tried to figure out whether women with BRCA1 or BRCA2 mutations who do develop cancer have worse outcomes than women without the mutations. They compared records for women with breast cancer and one of the mutations with those of women with breast cancer who did not have these gene changes.

Overall, they found that women with BRCA1 mutations had similar rates of metastatic (“distant”) cancer recurrence and death as women without it. Women with BRCA2 mutations had higher risks of recurrence and death, although the risk was similar when the women got adjuvant therapy (additional treatment to help prevent recurrences). Other factors like age and stage of the cancer also made a difference.

However, this study should be interpreted with caution. Bigger studies are probably still needed to properly understand any effects of these genes on women’s cancer therapy outcomes. The similarity of outcomes between women with and without the mutations may have to do, in part, with what we have learned about therapies for women with those mutated genes – which therapies don’t work as well for them, and which therapies might be added on for better outcomes. The researchers for the current study do say that women with mutated BRCA1/2 genes were more likely to have received adjuvant therapy, and the authors were unable to look at women’s results by how much chemotherapy they received.

While women who have BRCA1/2 mutations may be advised to have earlier or more frequent cancer screenings than other women, it’s not yet completely clear who should get tested for these mutations or if women should be tested once they’re diagnosed with breast or ovarian cancer.

As we learn more about how our genes affect our cancer risks and therapy outcomes, I expect we’ll see more and more news on these topics, and it may take some time to figure out how to assess risk, guide cancer therapies, and how our outcomes change based on this knowledge. Here are a few helpful resources for this growing area of study:

• Genetics Home Reference – Cancers – information from the National Library of Medicine on genes related to a number of cancers
• General Cancer Genetics Information – information from the National Cancer Institute on genetic (hereditary) risks for cancer, gene testing, a dictionary of genetics terms, and other resources
• My Cancer Genome – information intended to help inform physicians about tumor (not hereditary) genes and their effect on cancer therapy. Disclosure: I work with the team that produces this site.

A Doctor of Psychology candidate at Deakin University in Australia who is working on her thesis about the connection between a woman’s body image and her sense of well-being contacted us with a request to share a link to the online questionnaire where women 18 and older can participate in her research.

The questionnaire will ask you about how you feel about your body, behaviors related to your body, and how you feel about yourself in general. You can complete it online and they estimate that it should take no more than 20-30 minutes to complete.

The survey includes some questions about sexual orientation, height, and weight, as well as your satisfaction with specific parts and areas of your body and how much you think you resemble your “ideal” body. The researchers do mention that “The completion of this study may result in increased self-awareness regarding your attitudes and feelings about your body, yourself, and your life. For some individuals, this self-awareness may produce…discomfort.” Information about how your responses will be kept private is also provided on the website.

Last week, we wrote about a controversial decision by HHS Secretary Kathleen Sebelius, who overruled the FDA’s decision that emergency contraception should be made available over the counter to women of all ages.

On Friday, former FDA official Susan Wood issued her response to the move in the Washington Post, rejecting Sebelius’s claim that more data is needed on safety and label comprehension for the youngest of possible emergency contraception users:

…this type of age restriction, and worries about the use of medicines by teenagers, have not been applied to other products…Indeed, for no other over-the-counter medication has the FDA ever required extra data for a particular age group. (This extra data on younger teenagers was provided to the FDA in the latest application by the company.)

But somehow, the prescription requirement for Plan B — which is very safe and impossible to overdose on — remains in place for those younger teens who are in the unfortunate situation of being at risk of pregnancy and who need emergency contraception immediately.

Wood also notes that because the age restriction remains, access for older women remains restricted – emergency contraception is available without a prescription for those over 17, but is still behind a pharmacy counter.

Wood previously served as assistant FDA commissioner for women’s health and director of the Office of Women’s Health. She resigned in 2005 because of past politically motivated delays in emergency contraception approval, stating at that time:

I can no longer serve as staff when scientific and clinical evidence, fully evaluated and recommended for approval by the professional staff here, has been overruled.

Now, Wood calls out Obama for breaking his promise to the American people by allowing this overruling:

In his scientific integrity memo, the president stated: “When scientific or technological information is considered in policy decisions, the information should be subject to well-established scientific processes, including peer review where appropriate, and each agency should appropriately and accurately reflect that information in complying with and applying relevant statutory standards.”

In overturning the well-considered, scientifically based decision of the FDA, Sebelius and the Department of Health and Human Services certainly did not “appropriately and accurately reflect” the available scientific information…The president should stand by the principles of scientific integrity and restore science to its rightful place. He should support the FDA commissioner and direct the secretary to allow the agency to do its job. By doing so he will fulfill the promise of that beautiful day in March 2009 when he pledged that science would trump politics, not the other way around.

If you would like to write President Obama to object to Sebelius’s action and remind him to remember his promise about scientific integrity, you can contact the White House directly via this online form.

Yesterday, Health and Human Services head Kathleen Sebelius interfered with the FDA’s decision that emergency contraception could safely be made available over the counter (OTC) without a prescription to women and girls of all ages.

The drug is already available without a prescription for women 17 and older, after years of political wrangling. Advocates have worked to ensure OTC access because emergency contraception is most effective when used as soon as possible, and time, distance, money, and privacy can be serious barriers to getting a prescription and obtaining the drug in time to prevent pregnancy.

The FDA’s Center for Drug Evaluation and Research (CDER) had completed a review of the issue and concluded that Plan B One-Step emergency contraception should be available OTC to younger women, which Commissioner Margaret Hamburg explains:

Based on the information submitted to the agency, CDER determined that the product was safe and effective in adolescent females, that adolescent females understood the product was not for routine use, and that the product would not protect them against sexually transmitted diseases. Additionally, the data supported a finding that adolescent females could use Plan B One-Step properly without the intervention of a healthcare provider…CDER experts, including obstetrician/gynecologists and pediatricians, reviewed the totality of the data and agreed that it met the regulatory standard for a nonprescription drug and that Plan B One-Step should be approved for all females of child-bearing potential.

That’s when Sebelius stepped in and blocked the findings of CDER from taking effect. In her letter [PDF] overruling the FDA’s findings, Sebelius objected that “The label comprehension and actual use studies submitted to the FDA do not include data on all ages for which the drug would be approved and available over-the-counter.”

That data is not available for the vast majority of over-the-counter drugs on sale to all age groups without a prescription. Many OTC drugs (like acetominophen and aspirin) can have serious, even fatal, effects if taken inappropriately because of deliberate misuse or misunderstanding the label and instructions. You will not find data on safety and label comprehension for every possible age group for these medicines, yet they are readily available OTC in adult doses to consumers of any age.

Former FDA official Susan Wood – who resigned after a previous round of political interference in emergency contraception – agrees:

“They don’t do this for pain medication, headache medication, cold medication,” she said. “That’s not part of how we assess products. Are we going to go and now do this with all products, or are contraceptives once again being singled out for this special treatment and this extra standard when we’re talking about a very safe and very effective product that can really help women?”

Change.org has a petition up urging Sebelius not to let politics trump science, and objecting to the HHS leader’s focus on very young girls who may access the drug:

The fact that the HHS and the Secretary are focusing on this extremely young age group is bizarre. Less than 1% of 11 year olds are sexually active, where over half of adolescents have had sex before their 17th birthday.

This decision is illogical and unfounded. Physicians around the country agree that Plan B is incredibly safe and effective for all ages, helping to decrease the number of unintended pregnancies.

Further reading:
This NPR coverage provides a succinct timeline and political explanation of the controversy over accessibility of emergency contraception.

Statement from Physicians for Reproductive Choice and Health stating that the Obama administration’s “put[ting] politics before science and responsible health policy…is appalling.”

Heather Corinna at Scarleteen urges young people to speak up in protest of this action.

Jodi Jacobson at RH Reality Check, who reminds us that the previous administration wasn’t the only one playing political games with reproductive rights:

…no amount of proof it seems can make up for the fact that, despite all the evidence, even President Obama and Secretary Sebelius appear to think young women are too stupid to make their own decisions or that they are just chum to be thrown to the religious right in an election year. As the saying goes, with friends like these, who needs the far right?

We are delighted that Library Journal, a source of book reviews and professional information for librarians, has named the new Our Bodies Ourselves 40th anniversary edition one of its Best Books 2011 in the consumer health category.

Library Journal notes the incorporation of global perspectives and says the updated and revised title is “aging superbly.” Other recent mentions in the journal have called the edition “essential for public and medical libraries,” and “…still the bible for women’s health; an outstanding resource that belongs in all health collections.”

We’re always excited to get some love from the library community. In fact, the chapter on Navigating the Health Care System includes the following mention of librarians and libraries alongside other information about accessing and evaluating health information:

Increasingly, people can obtain access to research studies and other professional publications such as clinical guidelines through open access journals, through public access articles, or by requesting articles from a library. One benefit of using a library is that a trained librarian may be able to search for you or show you how to make the best use of databases. Some hospitals or treatment centers have libraries and services to help patients learn more about their condition. State universities with medical schools are often required to make their medical libraries open to the public, and the medical librarians at those institutions can offer expert assistance.

Still need to buy a copy of the new edition for yourself, a gift, or your library? Check out our information about online ordering and clinic discounts!

We have written several times here about concerns about bisphosphonates – a drug intended to prevent bone fractures – and the possibility that these drugs increase the risk of a type of femur fracture. While these fractures are relatively rare and not well understood, the FDA has said that patients should be made aware of the potential risk, especially with long-term use of the drugs. There is also debate over how much these drugs actually help prevent fractures and whether they should be used for prevention in people with “lower than normal” bone density who do not have osteoporosis.

The HealthCentral website has just published an interview on on spontaneous femur fractures with Dr. Jennifer Schneider, a physician who had been taking a bisphosphonate for several years when her thigh bone fractured as she stood on a New York City subway. In it, Dr. Schneider tells her story and explains the controversy over widespread use of bisphosphonates for osteoporosis prevention, the recovery process from drug-associated fractures, her testimony to the FDA, and other information about the drugs.

The new issue of the National Women’s Health Network’s newsletter, The Women’s Health Activist, also includes an article on this topic by Cindy Pearson. She writes about other women who told their stories of broken thigh bones to the FDA:

“They talked about turning to put a piece of paper in the trash can, stepping away from the kitchen sink, or walking down the sidewalk — and suddenly collapsing in agonizing pain as their leg gave way. All of these women had been healthy and active before their leg broke.”

The organization is working to get the FDA to make changes in how drug companies are allowed to market the drugs to healthy women. NWHN also recommends that healthy women under 65 with no risk factors for fragile bones avoid bone density scans because of concerns about accuracy and overtreatment; the US Preventive Services Task Force also focuses their recommendation for screening in women under 65 on those women who have risk factors.

On a related topic, I also have an article in this issue of NWHN’s newsletter about confusion over the risks and benefits of calcium supplements.

A recent Boston Globe Magazine feature “The C-Section Boom,” written by obstetrician Adam Wolfberg, discusses the high rate of cesarean sections as well as the variable rate between providers and facilities, possible reasons for the high rate, and potential approaches for reduction.

Wolfberg believes that the factors that contribute to the high rates include doctors’ convenience, fear of litigation, overdiagnosis of fetal distress, and previous cesareans. One particular statement laid out the power dynamic operating in many birth situations with a clarity I’ve rarely seen:

The truth is, an obstetrician can persuade almost any patient at any time that a caesarean is the best choice. I could have told this woman that the transient dips in the heart rate concerned me and that I recommended surgery to prevent her baby from being harmed. Few patients, hearing those words, would refuse.

Letters in response to the piece point to issues not fully explored by Woflberg. In her letter with Gene Declerq, a professor in Maternal and Child Health and the assistant dean for doctoral education at the Boston University School of Public Health, OBOS co-founder and director Judy Norsigian writes that while Wolfberg says previous cesareans often lead to future cesareans, he does not describe changes in the official ACOG position (2010) on previous cesareans, which presumably will allow for more vaginal births – and which potential patients could benefit from being aware of.

Wolfberg also doesn’t really discuss potential adverse health effects of cesarean, focusing instead on institutional costs as a downside. Another letter-writer, Beth Shearer, raises these concerns and advises doctors to be as wary of surgical risks during unnecessary surgery as they might be of the legal risks of not doing cesareans.

Meanwhile, the CDC’s preliminary birth data for 2010 shows the first – tiny – decline in the U.S. cesarean rate in more than a decade, after reaching an all-time high. From 32.9% to 32.8% of all births. And the rate actually went up for Black (35.4% to 35.5%) and Hispanic (31.6% to 31.8%) women. Here’s what the overall rate looks like over the last fifteen years:

As mentioned in yesterday’s post on the new book “What You Really Really Want,” this past weekend’s New York Times Magazine carried an amazing article  – Teaching Good Sex — that uses a Philadelphia private school’s approach to sex ed to illustrate a simple but controversial question: What if we actually taught young people about pleasure, orgasms, healthy relationships, and the wide variety of what is normal in both sexual desire and physical appearance?

I want to highlight one specific issue raised in the article — the lack of awareness among high school students about what women’s genitalia look like. While there has been little fanfare about the elective class so far, its instructor, Al Vernacchio, a well-liked and respected sex scholar who also teaches English at the school, notes that some lessons do draw more attention than others:

The lessons that tend to raise eyebrows outside the school, according to Vernacchio, are a medical research video he shows of a woman ejaculating — students are allowed to excuse themselves if they prefer not to watch — and a couple of dozen up-close photographs of vulvas and penises. The photos, Vernacchio said, are intended to show his charges the broad range of what’s out there. “It’s really a process of desensitizing them to what real genitals look like so they’ll be less freaked out by their own and, one day, their partner’s,” he said. What’s interesting, he added, is that both the boys and girls receive the photographs of the penises rather placidly but often insist that the vulvas don’t look “normal.” “They have no point of reference for what a normal, healthy vulva looks like, even their own,” Vernacchio said.

One female student remarked that when the class covered a biology unit, she was surprised she knew quite a bit about the opposite sex: “I probably would’ve been able to label just as many of the boys’ body parts as the girls’, which is sad. I mean, you should know about the names of your own body.”

Compounding the problem of a lack of education is that many students are relying on the most readily accessible photos of women’s naked bodies — media-distorted images and online pornography — and these images don’t exactly promote a realistic view.

I recall that my own sex education experiences involved uniform line drawings of healthy genitals and graphic photos of STI-affected genitals, but nothing visual, and especially not photographs, to indicate that there really is a wide range of what healthy genitalia look like. At Our Bodies Ourselves, we have a long history of encouraging people to grab a mirror and take a look at their own genitals, advice that shows up from the earliest to the most recent editions. Another good resource about women’s genitals is this article over at Scarleteen, which talks realistically about normal variation in size, shape, and color.

Meanwhile, there’s a petition at SignOn.org calling for better tracking of cosmetic genital surgery. The petition also wants surgeons who offer these services to “provide full information on genital diversity” when working with women who have concerns about the appearance of their genitals. “Without this information, women cannot make an informed choice,” the petition reads. It continues:

Most surgeons’ websites are loaded with photographs that misinform the public about female genital diversity. The “before” photos in the before-and-after online photo galleries depict a range of genitals as abnormal, but scientific studies show that many different shapes, sizes, and colors are normal. The photo galleries not only misinform, but they increase women’s and girls’ self-consciousness and add to anxiety. Photos may even be photoshopped or retouched.

This is a topic Heather Corinna also covers in the Scarleteen article, explaining that while some women do have physical discomfort or other medical reasons for wanting genital surgery, “for the most part, for nearly all women, your labia ARE normal, however much they vary. Beauty — as ever — remains in the eye of the beholder.”

That’s a lesson all students could benefit from.

The November/December issue of the Journal of Midwifery & Women’s Health has an article on nitrous oxide by Judith Rooks, a nurse-midwife and epidemiologist who has long advocated for making nitrous oxide available as a pain relief option for U.S. women in labor.

Nitrous oxide (N2O) is a gas that a laboring woman can breathe in through a mask.  It works very quickly, taking effect in about a minute, and wears off quickly.  Because it is administered by the laboring woman herself, it allows her to obtain a short burst of relief only when needed, as an alternative to an epidural. It is the most commonly used form of analgesia in the United Kingdom.

However nitrous oxide is not widely available in the U.S., despite the endorsement of various childbirth advocacy organizations, including the American College of Nurse Midwives.

In her article, Rooks reviews the research and literature on the safety and risks of nitrous use. She discusses questions around high and low doses of the gas, labor progress, maternal and fetal/newborn effects, and occupational hazards.  She notes that:

Because N2O/O2 labor analgesia does not have adverse effects that could threaten the safety of the mother or fetus, laboring women who use it do not need routine intravenous access, continuous electronic fetal monitoring, or other procedures that are intrusive and restrict the mother’s freedom of movement during labor. Nitrous oxide labor analgesia is safe for the mother, fetus, and neonate and can be made safe for caregivers.

The review points out several health concerns,  including that women who have had recent ear surgery (because of potential vomiting and inner ear pressure issues) and women who at increased risk of vitamin B12 deficiency may need special review before using nitrous, and that workplaces should take care to make sure the appropriate safety measures are taken to limit birth workers’ exposure. She also points to the need for additional research on issues like brain effects and occupational exposure in birth settings.

Although it’s only available to members, the American College of Nurse-Midwives also covered nitrous oxide in their recent Quickening newsletter. In it, they speak to Michelle Collins, CNM at Vanderbilt, who was instrumental in pushing for nitrous to be an option there. Collins explains several reasons women might choose nitrous: to take the edge off contractions, reduce anxiety, relieve discomfort while waiting on an epidural or during other procedures, or simply to delay epidural and keep more time available when the woman can be mobile.

Collins shares that in one month this summer, “35 women used the nitrous during labor at Vanderbilt, and of those, 22 used it as their sole analgesia. The remain­ing 13 used it and later had an epidural.”

For more on this topic, see this previous post with further discussion from Judith Rooks.

Tara Parker-Pope at the New York Times’s Well blog begins a recent post with a provocative question: Has the power of the mammogram been oversold?

It’s not a question that has been completely ignored – considerable debate erupted in late 2009 when the US Preventive Services Task Force released new guidelines recommending that women without higher risk wait until age 50 to begin routine mammograms.

Our Bodies Ourselves, the National Women’s Health Network and Breast Cancer Action all have previously raised concerns about the right timing and use of mammograms, especially in women without an elevated risk of breast cancer, but working against a popular myth that more mammograms sooner are always better for women’s health is a challenging task.

Parker-Pope explains:

…many doctors say it’s also time to set the record straight about mammography screening for breast cancer. While most agree that mammograms have a place in women’s health care, many doctors say widespread “Pink Ribbon” campaigns and patient testimonials have imbued the mammogram with a kind of magic it doesn’t have. Some patients are so committed to annual screenings they even begin to believe that regular mammograms actually prevent breast cancer, said Dr. Susan Love, a prominent women’s health advocate.

Her post also explains a study just released in the Archives of Internal Medicine, “Likelihood That a Woman With Screen-Detected Breast Cancer Has Had Her ‘Life Saved’ by That Screening.”

The Dartmouth researchers conducted a series of calculations estimating a woman’s 10-year risk of developing breast cancer and her 20-year risk of death, factoring in the added value of early detection based on data from various mammography screening trials as well as the benefits of improvements in treatment. Among the 60 percent of women with breast cancer who detected the disease by screening, only about 3 percent to 13 percent of them were actually helped by the test, the analysis concluded.

Translated into real numbers, that means screening mammography helps 4,000 to 18,000 women each year. Although those numbers are not inconsequential, they represent just a small portion of the 230,000 women given a breast cancer diagnosis each year, and a fraction of the 39 million women who undergo mammograms each year in the United States.

Do check out the rest of Parker-Pope’s post for further exploration of this controversial topic; the full text of the journal article has also been made available online for free.

Somewhat relatedly, Shira Sternberg writes at Public Responsibility in Medicine and Research’s Ampersand blog (no, not that Ampersand…) about breast cancer from her perspective as the daughter of daughter of “longtime PRIM&R friend” Pat Barr, who died of breast cancer eight years ago. Shira reminds us that there is still work to be done:

In 1991, 119 women died a day of breast cancer, today it is about the same, 110 women die daily of the disease. And this year alone over 230,000 women will be diagnosed with the disease. We gathered at the White House because we know we can do better.