Common Sense and Breast Cancer

The United States Preventive Services Task Force today reversed a seven–year–old recommendation and urged women to start screening for breast cancer at the age of 50, not 40.

"It also says women age 50 to 74 should have mammograms less frequently — every two years, rather than every year," reports Gina Kolata in the New York Times. "And it said doctors should stop teaching women to examine their breasts on a regular basis."

In what I feel will ultimately prove to be an understatement, Kolata writes that the guidelines "are likely to touch off yet another round of controversy over the benefits of screening for breast cancer."

Many people are interpreting that to mean that a woman's age should be the only determining factor. I don't think the guidelines are based exclusively on age, but, to be truthful, I haven't seen much justification for the revisions beyond age. Some but not much.

Kolata writes that the "modest benefit of mammograms — reducing the breast cancer death rate by 15 percent — must be weighed against the harms. And those harms loom larger for women in their 40s, who are 60 percent more likely to experience them than women 50 and older but are less likely to have breast cancer, skewing the risk–benefit equation."

It seems to me that a number of factors, like family history, need to be considered. Age is one factor, and it is clearly the one on which critics are latching, but it isn't the only factor. And, while Kolata provides dramatic numbers that indicate the risk does increase as a woman gets older, the task force apparently did take into consideration other risk factors.

It underscores the importance of communicating with your doctor. He can't reach an accurate conclusion if he doesn't have all the facts.

Whether your family has a history of cancer or not, if you have questions, ask your doctor. Then, together you can decide on what is best for you — even if it doesn't fit someone else's guidelines.

Common sense is called for.

And if you're going to do your own research, I always point in the direction of the American Cancer Society's website.

The ACS is kind of busy these days, preparing for the Great American Smokeout this Thursday. But it did post a response to the new guidelines. And I consider the ACS a valuable resource on cancer. Any cancer.

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"The American Cancer Society continues to recommend annual screening using mammography and clinical breast examination for all women beginning at age 40. 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."

Otis W. Brawley, M.D.,
chief medical officer,
American Cancer Society

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In the weeks and months ahead, I expect the revisions to be discussed extensively. And I wouldn't be surprised if one or both sides in the health care reform debate use the findings in an attempt to score a few points with the public.

If and when that happens, I expect the ACS to be fully engaged in the discussion.

Cancer is far too serious to be reduced to a political football.

Good (?) News About Bad Times

Earlier this week, CNN.com posted an article from Theresa Tamkins of Health that suggested that "a shaky economy might actually be good for your health."

Tamkins cites several studies that show that, in the past, mortality dropped and longevity went up during hard times. She focused much of her discussion on the Great Depression — what she describes as "the mother of all economic bad times" — but she observed that the same has been shown to be true, at least in terms of mortality, in regard to recessions in the 1980s and 1990s (obviously, it is still a little early to be reaching conclusions about longevity).

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Researchers estimate that around that time, a year with a 5 percent drop in the gross domestic product was associated with a 1.9–year gain in life expectancy, while a 5 percent rise in the GDP lowered life expectancy by about one to two months.

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During recessions, Tamkins writes,

• People tend to smoke less.


• People tend to drink less.


• People tend to drive less.


• People tend to eat out less.

All four can be explained as cost–cutting measures, just as they are today. Health benefits probably weren't considered.

Of course, people didn't know nearly as much about the ill effects of smoking during the Great Depression as they do today. Prohibition was still in effect in the first years of the Depression so it's hard to make blanket assertions about drinking habits during that period. Also, in those days, fewer people owned cars.

I wasn't alive during the Great Depression so I don't know how much dining out was affected, but my guess is that it was considered something of a luxury.

Another contributing factor, apparently, is that, during hard times, people do healthy things that they can control, like eating better and exercising. Well, some people do.

Tamkins acknowledges that "[s]uicides did increase during the Great Depression, but they made up less than 2 percent of deaths during that time."

Well, the monthly employment report comes out tomorrow. We'll find out then how many more folks can expect to live longer — and poorer — lives, thanks to the economy.

A Simple Twist of Fate

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Randy (right) and me standing in front of
a beer garden in St. Louis in 1987.

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Lately, it seems, this blog has been more devoted to personal matters than I would prefer, but I guess it's part of my nature to write about things when they happen. And I am reminded these days of how much is beyond my control.

This is my default position, I suppose.

Anyway, I received word that my best friend since high school, Randy, is in the hospital. He had a heart attack.

His ex–wife tells me his condition is stable, and the doctors haven't decided on his treatment yet.

It is a time of great awareness for me, I guess. The economy has already made me aware — along with millions of others — of my vulnerability. So many of life's events, most of which seemed, for so long, to be the domain of people in my parents' generation, have become part of my life and the lives of the people with whom I grew up.

People in my age group have been married, had kids, been divorced, lost parents. Some have lost siblings. Some have lost children.

And now, although I tend to associate heart attacks with people who are much older than Randy and I, my best friend has had one. Proof, perhaps, that anything can happen to anyone at any time, and preconceived notions mean little — if anything.

My thoughts keep returning to the days when Randy and I were in high school, working on a college campus maintenance crew in the summers. We've had many laughs together over the years, reminiscing about some of the things we had to do when we were 16 and 17. There were many things that we did for $2/hour in those days that we wouldn't dream of doing today, we assured each other — and, if we were coerced into doing those things now, we certainly would not do them for $2/hour!

In those days, our work shifts began at 7 a.m. I had access to a car, so I picked Randy up around 6:50, and we would drive to work. After work, Randy and I would go to his house or to mine. We would listen to the popular music of the day, and we would talk about the kinds of things that teenagers talk about — girls and cars, mostly.

Randy used to accompany me on my weekly visits to an elderly friend of mine, Aunt Bess, of whom I wrote last fall on the 20th anniversary of her death. She always got a kick out of us — two young men about to embark on an uncertain journey into adulthood.

In hindsight, I guess we were like most kids. We didn't think much about the future. We were focused on the here and now. That, I guess, is the great thing about being a teenager. It's all in front of you. You can still be anything.

But, when you get older, you become things — spouse, parent, employee. Choices are fewer. Responsibilities are greater. So are the pressures.

I hope this heart attack will not be debilitating, that it can serve as a second chance for Randy. I hope it inspires him to make wise choices. A couple of decades ago, Randy and his wife made me the godfather to their daughter. She now has a child of her own. I hope he will live to dance at his grandson's wedding — and, if his grandson follows the family tradition, Randy will still be in his 60s when that day comes.

Perhaps adjustments in Randy's lifestyle will make the difference. I don't know. But I hope so.

I still feel too young to lose my best friend.

Bad News if You Like to Grill

I guess it figures that I would come across this sort of news today. It is about 4 p.m. in Dallas, Texas. There's hardly a cloud in the sky. There's a moderate wind from the south. The temperature is 91° — and the forecasts say we'll be between 92° and 95° before we're through today.

All across north Texas — and elsewhere — I'm sure many folks are thinking about firing up the grill. But Consumer Reports Health Blog is determined to pour some water on their charcoal.

And the blog reports that University of Minnesota researchers have established a link between "grilled or fried meat that is very well done, burned, or charred" and a higher incidence of pancreatic cancer. The leader of the study, which was conducted over a nine–year period, said, "We found that those who preferred very well–done steak were almost 60% more likely to get pancreatic cancer as those who ate steak less well done or did not eat steak."

Well, when you think about it, it makes sense, doesn't it? Doctors have established the presence of carcinogens in most smoke, so it makes sense that food that is subjected for lengthy periods of time to smoke from charcoal would absorb a certain amount of those cancer–causing agents. I have no biological training, but I can grasp that.

And thus, the organs that are involved in digestion would be exposed to the carcinogens instead of the organs involved in respiration.

The blog says the risk can be reduced by:

• Cooking at a temperature below 325° F, the surface temperature at which heterocyclic amines (HCAs) begin to form,


• Marinating food before grilling, which research shows can greatly reduce HCA formation, and


• Not cooking food directly over the flame, because fat or marinade dripping on briquettes or gas flames can create flare–ups that contribute to HCAs and form other potential carcinogens.

But I have to wonder: Are there any special instructions if one cooks on a George Foreman Grill?

And does this only apply to red meat, or do you have to exercise the same caution if grilling chicken or pork?

Ted Kennedy Faces Surgery Today

In the last two weeks, Sen. Edward Kennedy has been consulting with his family, doctors and advisers and preparing a strategy to deal with his recently discovered malignant brain tumor.

Kennedy will undergo surgery today at Duke University Medical Center. The operation is to start around 9 a.m. Eastern time and is expected to last about six hours.

It's hard to believe that it's been almost 40 years to the day since Kennedy reminded a grief-stricken nation that his recently assassinated brother Bobby dreamed of "things that never were -- and (said), 'Why not?'"

It's ironic, too, because, 40 years ago, survivng the kind of tumor with which Kennedy has been afflicted was merely a dream for nearly everyone who was diagnosed with it.

But today, about half of the people who are diagnosed with Kennedy's kind of brain tumor are able to live more than a year after their diagnosis.

The odds aren't great. But they're better than they were.

It still helps if you have the kind of resources Kennedy has.