Should Women Get Mammograms at 40, 50, or Never?

Up until this point I've avoided writing about health care reform, or health care in general, because it's been too close to me. Even though many have urged me to tell my story on-line, I couldn't bring myself to do it. But the time has come when my story wants to come out. So think of this as the 'preface' where the author (me) is telling you, "This is MY story."

Living with a Chronically Ill Parent:

When I was 15 my father had a sudden stroke and lapsed into a coma for two weeks. This incident was by no means isolated, as twenty-seven years later he continues to have seizure and stroke activity on a somewhat regular, if not predictable, basis. The doctors are never quite sure what's "wrong" with him, but they can control the seizures with medication. Without medication, he surely would have died years ago.

You might think that this is a testament to the miracle of medical science, and I'm sure I would feel that way, too, if I hadn't lived it. The fact is, It's extremely difficult to have a chronically ill parent. At the time that I'm writing this, I'm just getting off an eight week stint of having my father in the hospital more than he wasn't. At one point he was unable to feed himself so I was going to the hospital before and after my day job everyday. I'm physically exhausted, and not doing so well emotionally, either.

What about the quality of life for this man? Don't get me wrong- I certainly don't wish my father dead- but it's beyond heartbreaking to watch someone fight for his life for 27 years. His body is slowly breaking down. He's suffered a heart attack brought on by years of having major and mini strokes, and his kidneys aren't functioning properly- most likely the side effect of years of prescribed barbiturates.

The Influence My Father's Illness Had on Me:

My father's illness has influenced me in two ways. First, I don't want to be kept alive by medication. Secondly, I don't want my loved ones to have to watch me suffer for decades. Unless you've been there - for 27 years- you don't know how hard it is. I don't wish it on anyone and I refuse to knowingly put anyone through that.

My Husband, His Heart Disease, and Our Medical Bills:

So, next thing you know it's 2008 and my husband needs an emergency quadruple cardiac bypass. Instead of the overly concerned wife that I should have been, I was so stunned all I could say was, "Are you freaking kidding me?" Long story short, he had the operation. (Later I found out that 30% of bypass surgeries are medically unnecessary.) Then we get whacked with a $35,000.00 medical bill. Even though we had been paying $113.00/week for health insurance and the bill only totaled $66K, we owed $35K. Now I was really like, "Are you FREAKING kidding me?"

Now, not only did I now have the nightmare of having my son live with an ill parent, we also had this large, unexpected medical debt to deal with. Since my husband was on disability because of having open heart surgery, we sought help for the medical bills. Could the hospital reduce it? No. Was the insurance claim accurate? Yes. Is there financial assistance for middle income households? No. Would the hospital put us on a payment plan? No. Did they accept partial payments? Yes, in the fact that they cashed the checks, but no in the fact that they sent us to collections within three months. (PS- We're still fighting that. It'll take 6-7 months to get it off our credit record.)

As an aside, my when my husband went for his check-ups after the surgery the doctor told him that his liver tests were abnormal, and he would need to begin treatment. I told him that there was no way we were taking on one more penny of medical debt, so he called the doctor to cancel the first of his liver treatment appointments. The next week we got a letter in the mail stating that his "liver function is improving".

The Influence My Husband's Illness Had on Me:

Strikes two and three on my own health care. Initially, I didn't want anyone to have to go through watching me "fight for my life" for years on end. (Strike one.) Then when this happened, I found the financial burden of health care, for lack of a better phrase, to be overwhelmingly ridiculous. I wouldn't knowingly put anyone through that, either. (Strike two). And the third strike against health care in the US- and, again, I'm at a loss for words- is that it was ironic that when we refused to pay for liver treatments, my husband's liver function improved. (Three strikes-you're out.)

So, What's All This Have to Do with Mammograms?

From my position, I'm in tune with all the unnecessary tests and expenditures used to prolong the quantity- not quality- of life. When the new mammogram recommendation hit the media, I wanted to say, "I told you so."

It shouldn't be surprising to hear that I'm a woman who's over 40 who's never had a mammogram. And I don't want to seem insensitive to women who have been diagnosed with breast cancer and went through radiation or chemotherapy treatments. I'm saying that it's not for me.

I'm also of the opinion that the health care system in the US is driven by greed. While many people will point the finger at the doctors, it's really the health insurance company executives who are responsible. If the government capped the earnings for the health insurance executives, health care in the US would be a horse of a different color. (To say nothing of a governmant cap on an individual's spending.)

Stats on Oncologists, Mammograms, and Chemotherapy

Back to mammograms.... It's funny that this assignment should come up while I was reading Superfreakonomics. The sections, "Why is chemotherapy widely used when it so rarely works?" and "We're still getting our butts kicked by cancer." seem particularly apropos.

In the former, Levitt and Dubner contend that "Oncologists are among the highest paid doctors... and they typically derive half their income from selling and administering chemotherapy drugs." While chemotherapy is effective for treating leukemia, lymphoma, Hodgkins disease, and testicular cancer; it has no effect on multiple myeloma, soft-tissue sarcoma, melanoma of the skin, and cancers of the pancreas, uterus, prostate, bladder, and kidney. But here's the kicker:

"Thomas J. Smith, a highly regarded oncology researcher and clinician at Virginia Commonwealth University, examined a promising new chemotherapy treatment for metastasized breast cancer and found that each additional year of healthy life gained from it costs $360,000.00 - if such a gain could actually be had. Unfortunately, it couldn't: the new treatment typically extended a patient's life by less than two months."¹

Conclusion:

As a consequence of my life experiences, I seldom go to the doctor. Oh sure, I'll go if I'm sick. But as far as all these extraneous tests, no thanks. I told my doctor, "If I get a mammogram and it comes back negative, you'll just send me for a colonoscopy. And when that's negative, too, it'll be time for a pap smear." You see, my point is that they (the doctors) will keep testing me regardless of the actual state of my health. I don't want to live in that mindset. (Yet I understand that there are people who insist on taking every medical test, and they're welcome to do so.)

What really resonates with me is this; "While many women do not think a screening test can be harmful, medical experts say the risks are real. A test can trigger unnecessary further tests, like biopsies, that can create extreme anxiety. And mammograms can find cancers that grow so slowly that they never would be noticed in a woman's lifetime, resulting in unnecessary treatment."²

I will continue to NOT get any of the recommended medical tests (which, as we know, extend far beyond mammograms). Of course, I'll visit the doctor when I'm sick. But if I'm really sick, I'll refuse any extraordinary life saving measures. I'd rather leave my destiny in the hands of Nature/Fate/God, than the greedy self-serving "professionals" who run our health care system. Plus, I wouldn't want my treatments to prolong my family's suffering and impose unnecessary hardship on them.

¹Superfreakonomics, Steven D. Levitt and Stephen J. Dubner, HarperCollins, 2009
^2"New York Times", Gina Kolata, November 16, 2009