Tuesday, Jul 20, 2010 6:40 PM UTC
Early mammograms and biopsies often turn up errors and misdiagnoses, says a new report
By Anna Clark
Just as the White House is affirming breast cancer screenings as key preventive care that will soon be accessible without co-pay, here comes news that the earliest screenings and biopsies are often pockmarked with errors. A New York Times report tells of cases like Monica Long, a nurse in northern Michigan, who was diagnosed with breast cancer after an early biopsy. She went through radiation, a partial mastectomy, and no small amount of emotional turmoil — only to learn, a year and a half later, that she probably didn’t have cancer at all.
It’s devastating. It’s deplorable. It’s other dramatic adjectives as well — but the most frightening one of all is that it is common.
How does it happen?
Ironically, it comes down to advances in screening technology for breast cancer. While sharpened tools for mammography and biopsies are intended to provide accurate screenings as early as possible, they in fact are putting pathologists in a position to determine whether the tiniest of images — the size of a grain of salt — are or are not indications of cancer. Common wisdom holds that the earlier cancer is detected, the better chances are for survival. Technology has brought us an inconvenient hiccup, however: We are able to detect the smallest manifestations of breast cancer, but the images are easily confused with tiny benign forms. In fact, the Times suggests that up to 17 percent of invasive breast cancer — ductal carcinoma in situ, or DCIS — is misdiagnosed through a commonly used needle biopsy. This isn’t exactly news, either. In 2006, Susan G. Komen for the Cure released a study that estimated that in 90,000 cases, women who receive a DCIS diagnosis either do not have the disease at all, or their pathologist makes a mistake that leads to them receiving the wrong treatment (too often leading to a change in the disease’s outcome). Each year, more than 50,000 American women are diagnosed with DCIS.
Diana Rowden, Susan G. Komen survivorship and outcomes vice president, told Broadsheet: “The takeaway is that breast pathology is a very complex science and art. Women need to be aware of this and not assume the first piece of information they receive is correct.” Rowden urges women to seek out specialists in breast surgery and pathology to ensure the most accurate results, either in person or by sending pathology slides elsewhere.
All the same, the federal government is maintaining its support for regular mammographies; the U.S. Preventive Services Task Force lists it as health care that must be available at no cost under new private health insurance plans. But this is the very same task force that last year suggested that women between the ages of 40 and 50 don’t need regular mammograms — a move that inspired no small amount of controversy. According to the Times, the federal government is also funding a nationwide study on the variations in technology used to detect breast cancer. And the College of American Pathologists intends to create a voluntary curriculum and certification program for pathologists who read breast tissue, requiring that they read 250 breast cancer screenings a year to be certified. (CAP is still urging women to receive screenings in order to detect the disease “in its earliest stages.”)
So maybe health strategies around breast cancer will catch up to technological advances. But in the meantime, the conflicting messages persist. Women who are diagnosed with the very early stages of breast cancer face a tough choice. They can take immediate action with treatments, including radiation and surgery, intending to increase their chance of putting the cancer into remission — this is what their pathologist, who diagnosed the cancer, will likely push — or these women can be cautious, holding off on treatment until there are more certain indications that the diagnosis was a mistake. Waiting could save them time, money and trauma — but taking action could save their life.
Rowden says the choice isn’t as urgent as it can seem, especially for a DCIS diagnosis. “So often, people feel like they have to make a decision now and have surgery next week,” Rowden said. “Waiting a few weeks is not going to change the outcome of most early stage breast cancer.”
Wednesday, Jul 14, 2010 5:25 PM UTC
Contraception fails to make the White House's list of free healthcare services -- but there is hope yet
By Anna Clark
Today the White House is announcing the list of preventative services that will be free under the new health insurance reform law. Cancer screenings (including mammograms and colonoscopies), obesity prevention, immunizations, blood pressure screenings, and smoking cessation programs will be available with no co-pay after September 23, according to the Wall Street Journal. Birth control, however, didn’t make the cut as a basic service that should be freely available.
This is both surprising and not-at-all surprising. On one hand, birth control access is one of the most all-encompassing of health care issues. The numbers tell the story: 62 million American women are in their childbearing years, according to a June 2010 Guttmacher Institute report. About half of all pregnancies in the U.S. are unintended — clearly, involving people across all political lines. By age 45, half of all American women will have experienced an unintended pregnancy and one-third will have had an abortion. Of the 43 million of sexually active and fertile women who do not want to become pregnant, 89 percent use contraception.
And how are they paying for it? While federal employees are guaranteed contraception coverage, only 27 states require employer-based insurance to cover the same. Meanwhile, 17.4 million people needed publicly funded services and supplies in 2008 because they either had an income below 250 percent of the federal poverty level, or they were younger than 20 years old. Use of publicly funded contraception increased by 6 percent since 2000. It is worth noting, by the way, that paying for birth control is far cheaper for insurers and public programs than paying for pregnancies or childbirth.
So when it comes to birth control as a preventive service, the need is consistent and sweeping. Given the rate of unintended pregnancies, existing insurance and public programs simply aren’t reaching all the people that need them. Affirming free access to a range of birth control options under the health reform law is an obvious and significant strategy to change this.
So what’s with the delay? Here’s the not-so-surprising part: birth control makes people think of sex. And given the unhealthy relationship public society has with sex — shifting uneasily between obsessed and appalled, judgmental and unknowing — there’s a knee-jerk reaction to publicly funded contraception as somehow a federal endorsement of — ironically — irresponsible sex. It’s the same illogic behind sex education programs that are mandated to be abstinence-only, as if any kind of education on what birth control is will incite kids to have sex (never mind the dangers of teens having sex without birth control). Indeed, despite the high numbers of people who use contraception, The Daily Beast’s Dana Goldstein numbers the organizations that are balking at the idea of publicly funding it.
Planned Parenthood Federation of America isn’t letting the conversation on contraception end here: it and other reproductive rights organizations are lobbying for contraception to be included in a separate set of guidelines on women’s health services. The Department of Health and Human Services is expected to spend the next 6-18 months considering whether insurance plans (both private and public) will be required to make contraception available with no co-pay. It must be emphasized, though, that birth control isn’t just a “women’s issue”; had contraception been on this initial list of preventive services, the government could have affirmed that message. Nonetheless, this issue of access is too important to quibble over semantics. Better to spend the energy supporting the campaign on basic contraception as a basic health care right.
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Tuesday, Jul 13, 2010 10:20 PM UTC
Canada moves to add this gender-based violence to its criminal code -- and the U.S. should follow its lead
By Anna Clark
Canada is on the verge of adding honor killings to its federal criminal code, affirming the practice of murdering girls and women who supposedly bring dishonor to a family as “barbaric cultural practices” and “heinous abuses.” Besides making honor killings a unique criminal charge, the Canadian government is looking at other strategies to address the gender-based violence, including the launch of television programs that will highlight the consequences of the abuse.
The government’s action seems to be prompted by a new report from the Frontier Centre for Public Policy. Released this past weekend, the report found that honor killings in Canada’s immigrant communities are on the rise. It emphasized that these crimes must be acknowledged as a practice that is unique from traditional homicide because of its cultural roots and the targeting of females, according to The Montreal Gazette. The United Nations estimates that each year 5,000 mostly Muslim women and girls are shot, stoned, strangled, stabled, burned, or smothered by family members with the intention of cleansing shame from the family’s name. While most of these crimes occur in the Middle East and South Asia, immigration is taking them around the globe.
Hardly limited to Canada’s border, honor killings have also made their way into the United States. Marie Claire recently published an extensive feature on the practice, numbering the women that have been murdered for ostensibly shaming their families in just the last few years. There were the two teen sisters in Texas shot by their father, apparently because they had boyfriends. A 19-year-old in Illinois killed by her husband after an argument about her Western-style clothing. A 20-year-old in Phoenix who was run over by her father in a parking lot while walking with her boyfriend’s mother. A 25-year-old woman in Georgia strangled by her father for wanting out of an arranged marriage. And a 37-year-old in Buffalo, New York beheaded by her husband for wanting a divorce. Typically chalked up to “standard” domestic violence or to cultural relativity, there has been little attention on these crimes as emerging from a unique practice, which, according to the Canadian report, is the key to effectively addressing them. These killings carry patterns that are unique from Western-style domestic violence — such as the approval of the surrounding culture and families.
Marie Claire and Human Rights Watch are partnering on a campaign to Congress to support the Family Violence Prevention and Service Act, which historically provided life-saving shelter for people threatened by family members — but the measure expired in 2008. The campaign asks Congress to reauthorize and fully fund the act, which was first enacted in 1984 and was supported by six votes to continue the services before abruptly falling flat two years ago.
Reauthorization needs to happen. But the U.S. would do well to also follow Canada’s model of particularizing honor killings as a crime. Currently, the federal Office on Violence Against Women has no unique listing for honor killings, nor do honor killings seem to be embedded in other listings. (A search on the site for “honor killings” produces zero results.) A Spring 2009 issue of Middle East Quarterly points out that the U.S. is also lagging behind Europe in responding to honor killings for what they are; that lack of acknowledgment means that the U.S. doesn’t have the special programs or training that could save the lives of girls and women who are under threat. While even the United Nations General Assembly was finally persuaded in 2005 to look at the specifics of honor killings, and while cases of honor killings within our borders are apparent, the U.S. has not followed suit. This is insensible, especially when international models already exist for how to integrate attention to honor killings with a broad strategy for eliminating violence against women and girls. Like Canada, it’s time to step up. After all, it’s not just our honor that’s at stake.
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Tuesday, Jul 6, 2010 5:45 PM UTC
The South African runner gets the go-ahead after forced sex testing -- but her struggle is far from over
By Anna Clark
Caster Semenya in April.
World champion Caster Semenya is back on track, literally. Nearly a year after the 19-year-old runner from South Africa was forced to undergo gender verification testing, the International Association of Athletics Federations announced today that it has cleared Semenya for participation in her sport. Effective immediately, she will finally be allowed to race in women’s events.
The IAAF, which is the governing body for track and field, said that it accepts the conclusions of the medical team that examined Semenya — though these conclusions, and all details, remain confidential, according to the New York Times. In a press statement, Semenya said: “I am thrilled to enter the global athletics arena once again and look forward to competing with all the disputes behind me.” Her first race after the long, unwanted, absence from competition may be at the African championships in Kenya in late July, or the Commonwealth Games in India in October, according to the Associated Press.
”We are delighted that Caster is finally being permitted to compete with other women, as is her legal and natural right,” her lawyer, Jeffrey Kessler, told the AP. “Hopefully, this resolution will set a precedent so that no female athlete in the future will have to experience the long delays and public scrutiny which Caster has been forced to endure.” Indeed, although that seems awfully idealistic. Semenya’s ordeal revealed a deeply ingrained discomfort with women who don’t have a traditionally feminine appearance. Women’s sports tends only to get the spotlight when it features “controversy,” rather than merely extraordinary ability, skill, excitement, and accomplishment.
It isn’t just plain old controversy, either. There was minimal coverage of WNBA star Diana Taurasi’s DUI awhile back, for example. The kind of controversy that carves out space for women in sports tends toward athletes who challenge gendered expectations. Consider Serena Williams losing her temper on the court; Baylor University basketball superstar Brittany Griner punching an opponent; the University of New Mexico’s Elizabeth Lambert bullying other soccer players on the field. These, along with Semenya’s story, were the headlines that got the most press in women’s sports over the last year. More than the (thrilling) WNBA championships. More than Lindsey Vonn’s skiing at the Winter Olympics. Without excusing the deplorable behavior of Griner and Lambert in particular, it’s notable that all the top stories feature female athletes exhibiting non-traditional characteristics in the public sphere. In the cases of the first three, anger, aggression, and competitiveness. For Semenya, it was mostly her strong body.
It is wonderful news that Semenya is free to compete again in a sport she clearly loves, with the full support of the IAAF. But it’s tragic that she was forced to endure global scrutiny, to say nothing of being sidelined from a year’s worth of racing while in the prime of her career. Even as she gets back to the starting block, she still faces an unsettling reality: It took cruel speculation about Semenya’s “true” gender for her to become world-famous; her profound skill wasn’t enough.
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Monday, Jun 28, 2010 6:10 PM UTC
A new anti-discrimination law may lift the age limit on state-sponsored treatments for infertile women
By Anna Clark
Britain’s National Health System just may lift a controversial age limit on free in-vitro fertilization (IVF). As it is, all infertile women between the ages of 23 and 39 can receive three free cycles of treatment through the national service — and the potential change would extend those services to women over the age of 40. The move is catalyzed by the Equality Act, which passed in the U.K. last year and broadly expands anti-discrimination laws.
But this change would be more than a simple expansion of services. Rather than using age as the indicator for whether to cover or not cover IVF treatment, the health system would use tests that gauge how many eggs a woman has left, or her “ovarian reserve,” according to the Sunday Telegraph. While diminished eggs correlates with age, it isn’t a straight parallel; under the new guidelines, younger women may be denied treatment, while older women may receive it. In efforts to meet equality guidelines, the National Institute for Health and Clinical Excellence — which oversees the NHS — is also looking into erasing rules that currently deny IVF to people whose partners have children in order to ensure that lesbians and single women have equal access to IVF.
IVF is a famously expensive fertility treatment, costing tens of thousands of dollars for each cycle. The NHS, meanwhile, is facing devastating funding cuts that affect thousands of jobs and patient services. The uncomfortable relationship here is not lost on the Brits. Columnist Melanie Phillips of the Daily Mail has gone so far as to holler that “IVF for older women on the NHS is another example of how the mania for equality is wrecking society.” More temperately, Christine Odone of the Telegraph distinguishes between “life-saving and life-enhancing” health treatments, arguing that the change in IVF policy would equate not having children with a cancer diagnosis. She puts the blame for these misplaced priorities on “our urge to control, our sense of entitlement, and a very greedy IVF industry.” And Josephine Quintavalle, of Comment on Reproductive Ethics, said that “The optimum age for a woman to have a child is around 24, so we should do more to encourage that. Instead we are talking about finding money — from where? — to give free IVF cycles to women over the age of 40.”
And yet, others contend that gauging coverage for IVF by ovarian reserve rather than age is a clear way to even out an arbitrary standard of care. The medical director of the Glasgow Centre for Reproductive Medicine, which hosts the world’s largest database of ovarian reserve records, reportedly argues that it’s time for institutional policy to catch up with science and research. Dr. Allan Pacey, a fertility expert from Sheffield University, is quoted in news accounts as saying that “I think it’s logical to move away from age guidelines to those based on ovarian reserve. It is very unfair at the moment.”
It’s a conversation that is hard to imagine ever having in the United States. Stateside, IVF treatments will probably never be subsidized for anyone; this is a country that hasn’t even agreed that primary care checkups are a basic right and in the national interest. It is notable, though, that the age Americans are having their first child is edging upward: About 20 percent of U.S. women now have their first child after age 35, even though about one-third of couples in which the woman is older than 35 have at least some struggle with fertility, according to the Centers for Disease Control and Prevention. Age is a primary factor in fertility challenges for men as well. According to the CDC, between 3.3 and 4.7 million men sought help with having a child at some point in their lives.
But regardless of whether anyone will ever receive a free cycle or two of IVF in the United States, it’s worth recognizing that Britain’s policies are being debated under the assumption of the Equality Act — legislation designed to codify fair access to public and privates services, as well as employment, regardless of gender, race, ability, sexual orientation, beliefs or age. As family planning evolves for people of all ages in the U.S., the principle of equal access to healthcare is one worth getting acquainted with.
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Monday, Jun 21, 2010 12:01 PM UTC
A Connecticut court asks whether competitive cheer meets Title IX gender-equity requirements
By Anna Clark
In a trial that kicks off today, a federal court in Connecticut is taking on the question of whether competitive cheerleading is a sport. The case appears to be the first that asks if Title IX standards for gender equity in sports can be met with high-kicks and pom poms.
Five women and a coach from Connecticut’s Qunnipiac University’s volleyball team are pushing the point in a lawsuit they filed after the school cut their sport — favoring instead to host a competitive cheer team, which it can field at less cost for more team members. The university contends that this is a legitimate way to meet the standards of Title IX, the federal law that requires equal opportunities for men and women in school athletic programs. But critics argue that the move cuts a team with legitimate student interest in favor of one that has no national precedent as an actual sport — all as a cheap way to inflate Title IX numbers that Quinnipiac must report to the federal government.
And speaking of those numbers, Quinnipiac has been hardly upfront with them; in fact, it’s been downright manipulative. In a guise of equity, the school has over-reported opportunities for female athletes, and under-reported opportunities for men, according to the Associated Press. Quinnipiac had the unfortunate habit of dropping players from the men’s baseball and lacrosse team just before it filed data with the U.S. Department of Education, and then immediately reinstating them. The school also added players to the women’s softball team just in time for the federal reports — while not acknowledging players that would be off the team when the spring season opened.
Today’s case, which is before Judge Stefan Underhill of the U.S. District Court in Bridgeport, has especially high stakes: it became a class action last month for “all present, prospective, and future female students who are harmed by and want to end [Quinnipiac University's] sex discrimination,” according to trial documents. This is an important point: class action ensures that any wins by the volleyball team who filed the suit won’t disintegrate when they leave campus. And as other schools flounder in their ability to manage diminishing budgets with equal opportunities, the results of the case will likely guide decisions that are happening on campuses across the nation.
And what of the cheerleaders? While physical effort and ability are a given for many of the high-level gymnasts who cheer, Title IX has specific criteria for what counts as a sport when it comes to equity in athletics: a program must have a defined season, a governing organization, and feature competition as its primary goal. Competitive cheer is not recognized by the National Collegiate Athletics Association (NCAA) as a sport. Nor does it have a governing body: two versions of organizations that have filled the role have been associated with Varsity Brands, Inc., a for-profit company that sells cheerleading gear and hosts up to 60 “national championships” a year. To amplify its case that competitive cheer can indeed count as a varsity sport, Quinnipiac has joined with seven other schools to form the National Competitive Stunts and Tumbling Association, which is intended to be a new governing body for the sport. Four more schools need to sign on for it to be recognized as a legitimate governing body, and the sport itself to be seen as “emerging.”
Despite being forced to host a women’s volleyball team this year after all and not cut any other women’s teams (thanks to a temporary injunction from Judge Underhill), Quinnipiac went ahead with its plans to form a varsity cheer team. It did, however, hastily cut its men’s golf, outdoor track, and indoor track. The move is a sad one that feeds the idea that it’s a zero-sum game in athletics — if women’s sports win, then men’s sports lose. Given that Title IX is well-established law, it is a tired point. Calling for excellent and numerous opportunities for women to play sports is not the same thing as calling for the dismantling of men’s programs; the Title IX vision is for these programs to co-exist, even compliment one another.
Now, it’s possible that competitive cheer could be a legitimate sport. I’m open to the point. But what a sorry birth it would be for varsity cheerleading if it were to come out of a swamp of data manipulation and lawsuits that pit sports against one another, making a mockery of any claimed commitment to the participation of women in athletics. In this case, I’m cheering for the volleyball team.
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