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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.

Life’s Way Station August 31, 2009

Posted by Kate Ryan in Motherhood, Parenting, popular culture, Women's Issues.
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Empty-Nest-%232My nest is empty.

On Saturday, Mr. Kitchen Table and I took our daughter two hours down the interstate and left her in a tiny cinder-block room in a city where she knows nobody.  Of course, this place is commonly known as a college dormitory and countless parents have made the same trip – but to us it felt like abandonment of the highest order.  My anxiety was boundless, both before the drop-off and since, though I truthfully believe that we feel more abandoned than she ever would.

I really thought that this would not affect me this way.  John and I have been rather looking forward to this.  If you ever shared a house with a self-centered 18-year old girl, you would understand why.  We were so very tired of arguing the same arguments over and over again because, of course, nobody knows more than a self-centered 18-year old girl.  We were so ready!

Also, John and I had spent a few years just the two of us before she came along.  We went places on the spur of the moment, stayed in bed all day with the Sunday paper, and spent money on frivolous things.  We always knew exactly where our car was, the towels were always hung up in the bathroom, there were no piles of junk on our dining room table, and when we reached in our pockets – there was usually some money.  We were really anticipating getting at least something of those days back. 

What we didn’t anticipate is the overwhelming emotion.  As our daughter stood in the middle of her dorm room (which, to me, looked vaguely reminiscent of the cells in “Lockup” on MSNBC), all I could see was a little girl in her plaid Holy Family Elementary School uniform beaming with excitement on her first day of school.  I saw the anxious face of the first-time Girl Scout camper as we waved goodbye for a week of camp.  I heard the laughter of my companion on our various road trips and the cries of a high-school freshman that lost a schoolmate to a car accident.  I felt the arms that surrounded and comforted me when my parents died.  Then, I saw a beautiful and confident young woman standing there and almost didn’t recognize her. 

I said goodbye to her through some tears and hurried to get to the car.  I am ashamed to admit that since we dropped her off, I have sent four text messages and made two phone calls.  I need to constantly reassure myself that she’s OK.  Though I might have glimpsed an adult standing in that dorm room, I still have a little girl, whether she thinks so or not. 

Right now, my daughter and I are parked in one of life’s way stations.  She’s too grown up to live with curfews and restrictions, but not mature enough to be totally independent.  For me, I need some time to be able to trust in her and completely let go.  I think this must be why they invented resident colleges, to hold you in semi-independence until you are really ready to be out on your own.

My nest may be empty, but most of my friends who have already gone through this have told me not to worry.  Often, the chicks come back and fill it up again – which is a totally other column!