Cancer
Hold off on that mammogram?
New guidelines for breast cancer screenings say you can wait -- but should you?
On a beautiful June Saturday last year, my friend, neighbor and comrade in motherhood Martha died of breast cancer at age 45. Summer dissolved into fall, and when our community returned in September, I noticed another friend, her head swaddled in a scarf, in the schoolyard. She was in her mid-40s, and in the midst of chemo for breast cancer. (And thankfully, she’s currently doing great.)
But my friends aren’t the only reason that I’m skeptical of the new U.S. Department of Health and Human Services guidelines that have raised the suggested age to start getting mammograms to 50. The recommendations, which went off like a bombshell earlier this week, not only up the screening age by a full decade, they go on to suggest mammograms only every two years for women 50-74, and to discourage self-exams, which have never been conclusively linked to mortality prevention.
Why the sudden change? The report, the department’s first in seven years, notes the high prevalence of false positives for mammograms, “which can cause anxiety and lead to additional imaging studies and invasive procedures (such as biopsy or fine-needle aspiration).” Frankly, given the choice between “anxiety” or not living to see my children grow up, I’d go for the first one. But the report does make a persuasive case that not all cancers are life-threatening, and that “over detection” and “over treatment” pose their own — often considerable — health risks. And at the heart of the new guidelines, which are similar to those from the World Health Organization, is the sobering fact that detection is not the same as curing anything.
The American Cancer Society promptly shot back that it’s sticking by its recommended guidelines to start mammograms at age 40, noting that “Our experts make this recommendation having reviewed virtually all the same data reviewed by the USPSTF, but also additional data that the USPSTF did not consider.” The American College of Radiology went even further, saying that the “cost-cutting” recommendations “will result in countless unnecessary breast cancer deaths each year.” Noting the steep decline in breast cancer rates in the last three decades, the ACR said that “At least forty percent of the patient years of life saved by mammographic screening are of women aged forty-49.” And Florida Rep. Debbie Wasserman Schultz, who detected who own breast cancer via self exam at age 41, lambasted the guidelines as “totally inappropriate.”
Yet there’s plenty in the new guidelines worth considering. The radiation from regular mammography poses a health risk of its own. And loathsome as the American College of Radiology may find the phrase “cost-cutting,” the truth is that mammograms are expensive. Want a potentially better healthcare system for everybody? Then we need to reconsider what’s necessary and what’s optional.
But what’s optional for one woman may be the difference between life and death for another. The U.S. National Institute of Health itself estimates that a woman aged 30-39 has a 1 in 233 chance of being diagnosed with breast cancer. For women 40-49, those odds leap to 1 in 69.
A birthday isn’t an automatic excuse for anything other than cake. I didn’t run out and get me a big old burst of breast-centric radiation the day I turned 40 (I must have been getting one of those abortions of which we feminists are so very fond), any more than I’m going to shrug my shoulders and figure I can worry about cancer when I hit the magic half-century mark.
I’m a healthy woman under the age of 50. There’s no history of breast cancer in my family. And I wouldn’t mind blowing off those cold, painful dates with the machines that squeezed me so hard I cried at my last appointment.
But not so fast. I grew up in New Jersey, which has one of the highest breast cancer rates in the country. I started menstruating young. I smoked. I had my first child in my mid-30s. All of which are risk factors. And, as I’ve learned from the mammograms I did start at age 41, I have dense breast tissue, which means that not only do I run an elevated chance of developing breast cancer, it could be harder to detect if I do get it.
I’m no believer in the word “routine,” whether applied to getting a procedure or skipping it. Healthcare is about active self-advocacy and not being shy about speaking up. Every woman with an opinion about breast cancer has to figure out her own risks — and share them with her doctors. I’m not my age. I’m not my breasts. I’m not the 10:15 appointment being hustled out the door before the 10:20 appointment. Blanket guidelines are just that — they’re fine for covering the many, and they are not laws we have to follow. They don’t mean much to my little neighbor who lost her mother the day after she finished kindergarten. And they’re no substitute for the individual care the rest of us who plan on making it to 50 need and deserve.
Mary Elizabeth Williams is a staff writer for Salon and the author of "Gimme Shelter: My Three Years Searching for the American Dream." Follow her on Twitter: @embeedub. More Mary Elizabeth Williams.
Kate Hudson’s cancer horror show
The bubbly actress's horrific movie, "A Little Bit of Heaven," turns terminal illness into a twee joke
Kate Hudson in "A Little Bit of Heaven" Ladies and gentlemen, we are gathered here today to mourn a sad loss. A luminous, unique presence who ably graced our lives and then was snuffed out far too early. A moment of silence, please, for Kate Hudson’s career.
It seems like only yesterday we were beguiled by the lively, bohemian Penny Lane in “Almost Famous.” But it’s been a painful decade since, as I know many of you gathered here can bear witness. Those of you who steadfastly supported Hudson over the years, who paid good money for “Bride Wars,” for “How to Lose a Guy in 10 Days,” for “Raising Helen,” “You Me & Dupree,” “Fool’s Gold,” “My Best Friend’s Girl,” “Alex and Emma,” “Le Divorce,” and “Something Borrowed” — you know what I’m talking about. You’re heroes for sticking around this long. That’s why it’s both tragic and necessary to come to the end of our journey now, to let her go off to a better place. The D-list. It’s called “A Little Bit of Heaven.”
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Mary Elizabeth Williams is a staff writer for Salon and the author of "Gimme Shelter: My Three Years Searching for the American Dream." Follow her on Twitter: @embeedub. More Mary Elizabeth Williams.
Lessons of a baby bucket list
Avery Lynn Canahuati accomplished a lot in her six months of life. Imagine what the rest of us can do in a lifetime
Avery Lynn Canahuati (Credit: http://averycan.blogspot.com/) What have you accomplished since November? What dreams have you fulfilled? In that time, Avery Lynn Canahuati threw out the first pitch at a baseball game, got a letter from the president and dressed up like a troll doll. She experienced deep love, and changed the lives of her family and friends. And that’s just what Canahuati got done in the first six months of her life. They were also the last.
Canahuati was born in Texas on Nov. 11. This past Good Friday, she was diagnosed with spinal muscular atrophy (SMA), a group of rare neuromuscular diseases that, in her case, were terminal. “We asked our doctors specifically if there is anything. Is there trial drugs, anything out of the country?” her mother, Linda, told CNN this week. So after “sitting around for two days crying and being devastated, since there is no cure and there is nothing we can do,” her father, Mike, decided to make the most of what was left of his daughter’s cruelly brief expected lifespan. Writing in Avery’s voice, he created a blog — and set a few goals.
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Mary Elizabeth Williams is a staff writer for Salon and the author of "Gimme Shelter: My Three Years Searching for the American Dream." Follow her on Twitter: @embeedub. More Mary Elizabeth Williams.
Words we had after he died
When we lost my husband to cancer, my family's world went upside down. We made sense of it the best we could
(Credit: Tinga via Shutterstock) On the day my husband died, our daughter Allison started screaming my name from her bedroom, where she’d taken refuge. I burst open the door, imagining she had hurt herself, but she was just standing there in the center of the room. “Mom. Mom,” she said. “You are a widow now. A widow. I don’t want you to be a widow. You can’t be a widow.” I had to agree: It just didn’t seem possible.
I tried to hold her, but she was hyperventilating a bit. “I’m ‘the girl whose dad died when she was 13′?” she choked out. “Oh my God. That’s who I am now. When people ask me what my dad does, or how we get along, or anything, that’s how I will have to answer: ‘My dad died when I was 13.’”
Continue Reading CloseKathleen Volk Miller is co-editor of Painted Bride Quarterly, co-director of the Drexel Publishing Group and an Associate Teaching Professor at Drexel University. She is a weekly blogger (Thursdays) for Philadelphia Magazine's Philly Post and is currently working on a collection of essays. Follow her @kvm1303. More Kathleen Volk Miller.
Look at my scars
The remnants of my own illness have taught me that when it comes to difference, don't stare -- but don't turn away
(Credit: Natalia Klenova via Shutterstock) “Do I freak you out?” she had asked.
It was the kind of question adults rarely pose. But Abigail (a pseudonym, like some other names in this piece) is 8, and she doesn’t have any qualms about being direct. The person she was asking, my daughter Beatrice, likewise didn’t hesitate in her reply.
Abigail is new to our school this year. She is in every way a typical second-grader, except that she was born without a left hand. It’s a trait that makes her undeniably noticeable, and so, sometimes, people ask questions. Sometimes Abigail has questions of her own. Sometimes, when you’re different, you want to know.
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Mary Elizabeth Williams is a staff writer for Salon and the author of "Gimme Shelter: My Three Years Searching for the American Dream." Follow her on Twitter: @embeedub. More Mary Elizabeth Williams.
Confronting cancer webcast
Full videos posted for Salon Core conversation on "coming out of the sickness closet" VIDEO
My oncologist says that whoever came up with the phrase “the gift of cancer” has the worst taste in gifts she’s ever heard of. But though it’s not exactly a set of car keys under the seat, cancer has, for the past year and a half, been the gift I’ve been given. And from an initial malignant diagnosis of melanoma through surgery through a Stage 4 rediagnosis through a last-ditch, Phase 1 clinical trial to a recovery that has stunned the research community, I’ve shared this adventure with the readers of Salon. And along the way, you’ve given so much in return. You’ve told me your own experiences with illness, with the healthcare system, with grief and frustration, and with the ways a shattering experience — either your own or that of someone you love — can turn life around. Sometimes even for the better. So it was a unique privilege to get to talk to a few of you recently for a Salon webcast, and answer your questions on life here in Cancer Town. For those of you who couldn’t make it live, videos of the full webcast are posted below.

Mary Elizabeth Williams is a staff writer for Salon and the author of "Gimme Shelter: My Three Years Searching for the American Dream." Follow her on Twitter: @embeedub. More Mary Elizabeth Williams.
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