Probably the single biggest frustration that I have with medicine today is summed up nicely by this article about mammography in today's Post. I'm a 30 year old woman who, about five years ago, found a lump in my right breast. It turned out to be nothing, but that's the kind of anxiety that stays with you. I've spent a fair amount of time reading up on the benefits, drawbacks, and questions surrounding mammograms, and the result is that I am now a very angry 30 year old woman.
It's pretty clear that the future of cancer detection is "cancer markers", such as the Prostate Specific Antigen (PSA) blood test. Unfortunately, research is a slow process, and today's apparent breakthrough may not translate into medical miracles for decades. While it seems intuitive to think that the body will produce a chemical marker for pretty much every occasion, learning to isolate the signal from the noise in a disease process (or even in perfect health) is largely a trial and error process.
But in the meantime, the docs have to get better about what they consider a definitive test. Last week, the American Cancer Society and the New England Journal of Medicine both recommended MRIs for several groups at high risk for breast cancer, but cited both the high cost and the high false-positive rate as reasons to discourage MRIs for everyone.
So this seems to be the current patchwork of activities known as breast cancer screening:
- Monthly self-exams, beginning at age 20
- Examination by your doctor at annual physicals
- Annual mammography starting at age 40
- Pray that you don't miss it in your self exam, and that it isn't hiding in some out-of-the-way-locale that a mammogram will miss
Women need a solid, standard, predictive blood test. Women need this test to be administered every time they see their doctor. 212,000 American women are diagnosed with breast cancer every year, and 40,000 Americans die annually from breast cancer. Where is our PSA test? Why, in 2007, is there not a standard screening process that 99% of doctors agree is effective and definitive?