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The Breast Defense November 22, 2009

Posted by Kate Ryan in Breast Cancer, Health Care, Public Health, Women's Issues.
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Ahem.  Now that I have your attention…

The American culture has always been absolutely obsessed by the breast.  As women, in may ways we define ourselves by our breasts; are they big enough, firm enough, round enough?  We alter our bodies with baggies full of synthetic material to get the perfect breast.  Our breasts are enormous parts of our sexuality and, at the same time, are de-sexualized as the means by which we nourish our children.  Our breasts are loved by men, hated by us, celebrated in art and culture, and glorified as the pinnacle of female perfection.  Is is any wonder, then, why the idea of breast cancer – and the possible resulting treatment of a mastectomy – absolutely terrifies the bejesus out of us?  Is it any wonder, then, why we can not look at the facts of breast cancer and separate it from all the pink-ribbon mythology?

Last Monday, The United States Preventative Services Task Force released new guidelines for breast cancer screening and caused the proverbial shit to really hit the fan.  The task force recommended that women – who have no risk factors for breast cancer – forego routine mammography until age 50 and follow-up with scans every two years.  These new guidelines are a radical departure from current practice.  Most women are sent for their first mammogram at age 40 and continue with annual screenings regardless of personal risk factors.  The reasoning behind the new guidelines was that when the entire body of evidence surrounding breast cancer is reviewed, routine screening before age 50 finds cancer in only about 1 out of 1900 patients.  This figure is consistent with the number of women who have very high risk factors for the disease.  The panel also found a high incidence of false positive test results, leading to more invasive screening, including biopsy, and a rise in patient anxiety and distress.

By Monday night, the news was full of contrary opinion.  Every breast cancer advocacy group was on TV shouting that these new guidelines would kill women.  There were reports from women who stated that had these new recommendations been the protocol their cancers would not have been found early and they would be dead right now.  The lone voice in the wilderness, it seems, was Dr. Nancy Snyderman of NBC, who urged calm and asked that people try to divorce themselves from the emotion of the issue and look at the science.  On Tuesday morning Dr. Snyderman again tried to urge dispassion on “Morning Joe” on MSNBC, only to get caught up in the host’s near-hysterical argument that if his wife or daughter gets breast cancer 20 years from now and could have been saved by early screening, he will remember her words.  On Wednesday, HHS Secretary Kathleen Sebelius threw the government’s own scientists under the bus by stating that, “we will continue to test as we have been testing and will not follow these new recommendations for now.”

Is it possible to divorce the disease from American breast mythology and just look at science?  Not unless you can also divorce the science from the high-stakes research funding game and all the stakeholders in that game who need to keep their dogs in the hunt.  As I see it, that’s the real problem.

There is an enormous amount of research dollars that go to breast cancer – both public and private.  On the public side, breast cancer research is funded to the tune of $700 million per year (according to the National Institutes of Health).  This is more than Alzheimer’s Disease ($656 M), coronary heart disease ($397 M), stroke ($342 M), and lung cancer ($289 M) – yet women are more likely to be stricken and die from any of these other diseases rather than breast cancer.  In 2005, 88% more women died from coronary heart disease than from breast cancer.  The top five killers of women are, in order, heart disease, stroke, lung cancer, lower respiratory disease, and Alzheimer’s disease.    Breast cancer comes in seventh – after accidents – but its research is funded higher than any of these.  Lung cancer, for instance, is extremely malignant in women, yet research is funded at less than half the level. 

The best things that breast cancer research has brought us is the identification of risk factors.  Chief among these is that there is a genetic component – 5% to 10% of all breast cancer are gene-related.  Also, having a first-degree relative with the disease is a known risk.  Other benign breast disease, early menstruation, late menopause, childlessness, and high-fat diets are also known as risk factors.  Women with a multiple of risk factors are the ones most likely to benefit from early screening – and there is nothing in these new recommendations that will prevent this.

I had my first mammogram at age 4o.  I am 47 now and have not had another since.  Why?  Because my personal risk factors and lifestyle do not indicate that I will become a victim of this disease.  My doctor and I have discussed this and she agrees that I probably would not benefit from more screening.  What I – and my doctor – seek to prevent is heart disease and stroke, which have been the biggest killers of women in my gene pool.  Does this mean that I will never get breast cancer?  No, but it means that we have looked at the risks to my health and have decided to get the most bang for our buck looking elsewhere.

That is what these new guidelines are all about.  Every woman, and man for that matter, needs to be able to personally develop a screening and treatment profile that best benefits them as an individual.  Health care is not a game to see what disease or what agenda will receive the most funding, and breast cancer should not be elevated above all other women killers because of the personal and sexual nature of the disease.

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I’m Back! Did you Miss Me? November 4, 2009

Posted by Kate Ryan in Barack Obama, Democrats, Economy, Health Care, National Politics, Obama Administration.
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relaxed_kittenIn case any of you were wondering, my kitchen table has taken a very much-needed vacation from the blogosphere.  Thanks to all of you regular readers who stuck with me and sent messages wondering if I were sick or expired.  Obviously, neither was true, but as October wore on I believed my left-wing head was going to explode.  A vacation was certainly in order.

The reason for my distress, of course, is the fact that the change I believed in seems to have turned into the same old crap dressed up like change.  The Health Care reform debate finished me off.  We want a public option, no we don’t, how about a trigger?  Well, we got Olympia Snowe, NOT!  Harry Reid says the public option is back in.  Oh, wait, he doesn’t have the votes.  Traitor Joe Lieberman is rearing his (very) ugly head.  At least the Speaker of the House supports a robust public option – oops – no she doesn’t.  She watered it down in the final bill.  Mary Landrieu supports the trigger, and Joe Lieberman will not vote to filibuster.  Oh, wait, yes he will.

WTF????

There is a growing sense of frustration – not just in me, but in many Progressives, Liberals, and Independents who supported President Obama’s election just one year ago.  While we understand that it is more difficult to govern than to electioneer, but the pace of this administration has just been too damn slow.  Instead of taking the bulls by the horns and forcing the necessary changes, the Obama administration has played their agenda carefully and pragmatically.  In doing so, they have lost momentum and support.

Take health care, for instance.  President Obama should have told Congress – “I want a bill on my desk June 1st.  It has to do x, y, and z.  It has to have a medicare for all option.  It should be deficit-neutral, but that’s not the most important thing.  Do it.”  At that time, the momentum was there.  There had been no tea parties, no disruptive town-halls, no Glenn Beck.  The Republicans were in disarray and could not have mounted a strong opposition.  Had they threatened a filibuster, the time was ripe to call their bluffs.  The American people were in a mood to want this President to succeed and would have railed against the Republicans as obstructionist.  Instead, the endless delays and efforts for bipartisanship have led to a reform bill that is so weak that it is being set up to fail.  The President seems willing to accept this garbage just to check off a “win” box next to his name.

The same is true with the economy.  Everyone KNEW that unemployment was going to be a big problem.  The administration even mentioned it in the stimulus legislation.  But instead of a huge jobs bill, we got big chunks of money going to near-broke state governments that has mostly been used to prop up the state governments.  The financial bail-outs did little to get money to regular folks like you and me, in fact, many of us are feeling more squeezed than ever.  But we are expected to celebrate a 150-point rise in the Dow.  Huh?  That doesn’t pay the heat bill.

I heard one of the talking heads on TV the other day saying that the President’s sliding approval ratings are an indication that the American people believe he is trying to do too much.  Guess again.  They are an indication that he is not doing enough.   We didn’t just send Barack Obama to the White House.  We gave him majorities in Congress to ensure that stuff gets done.  We expect more leadership from this President to get his troops in line.  I hate to say it, but you have to admire the Republican’s ability to bully everyone into position.  This guy needs that kind of “cock-sucker-ness” in his circle (maybe James Carville is available).

Last night’s election results had lessons for this President and the Democratic party that I hope they will heed.  First, New Jersey and Virginia showed that if the jobs don’t come back, this party is toast.  Second, and more important, was NY 23.  Democrats are crowing that the Republican’s “ideological purity” test didn’t seem to work.  It came close, though, and had the Conservative candidate gone through a primary with  the chosen Republican, he very well may have won a district that no Democrat had ever won before.  Huge numbers of base voters turned out to vote and very nearly swung the race the other way.  By the same token, liberal and progressive base voters stayed home in New Jersey and Virginia, and handed the win to the Republicans.  

 The message of these elections, I believe, is clear.  Ignore your base at your peril.  There SHOULD be an ideological purity test for candidates.  They can run in the general elections as being moderate to attract Independent voters, but their core principles should be shared by all of them.

Great to be back!