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What's a Woman To Do About Mammography?

A Commentary By Susan Estrich

Saturday, November 21, 2009

So, as it turns out, did I not need to have my breasts squeezed in the mammogram machines every year between the ages of 40 and 50? Could I have missed the two scares in there, especially the one when both of my kids were babies?

Maybe. Or rather, in my case, thank God, yes. Then again…

When I saw my doctor yesterday, the one I have trusted with my life and the lives of my children for all these years, the one who sent me for all those tests, I asked him if he would still be sending his women patients who are in their 40s for mammograms. The short answer is yes.

The longer answer is that you practice medicine on an individualized basis. While certain things may be true as a matter of "public health" -- like the costs of early mammograms outweighing their benefits -- that doesn't mean they're true for you. My doctor has been spacing out scans for women in their 40s with no risk factors for some time, sending them every 18 months instead of every year. But he's seen too many cases of women who had no risk factors and still developed aggressive cancers in their 40s to delay for a decade.

That's what I thought. And what I'd do. The truth is, I'd rather be safe than sorry. I'd rather worry needlessly than die needlessly. Who wouldn't?

The White House was quick to point out that this week's recommendation does not mean doctors should stop sending women for mammograms, or that insurance companies will be allowed to stop paying for them.

Of course it means that. Maybe not this month or this year, but isn't that what cost control is all about? Sure, get rid of waste and abuse and needless paperwork, but is there anyone who doesn't see a future in which tests that can't be justified on "public health" grounds don't get covered by insurance?

I always ask doctors, particularly on women's health issues, what their wives do. Ask any doctor if his wife is going to wait until 50 to start mammography, and I will lay down bets on the answer. Does that mean the federal government should pay for every woman to do the same? Maybe not. Does it mean that I expect my private insurer to do so? I do.

Like many women who have had some scares along the way, not to mention some relatives with breast cancer, I've been "lucky" enough to have years of multiple mammograms and advanced screenings. You think insurance notices when you have a second mammogram? The answer is yes.

Do they figure that anyone who is having two mammograms in a year must have a very good reason to do so, since most of us find it hard enough to have one? No. More than once, I have stood at front counters of testing centers discussing why it is that my insurance company has not approved the test I am scheduled to have. And, mind you, I'm good at this.

So I'm glad to see that everyone is focusing on what's best for women, but ultimately the answer is that, as always, these are issues for a woman and her doctor. And hopefully, once they decide, the insurance companies won't just say no.

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