The real No. 1 killer of women

Turning attention toward real No. 1 killer of women

March 05, 2002|By Susan Reimer

BREAST cancer is not the No. 1 killer of women. Heart disease is, and the latest skirmish in the Mammogram Wars worries me because it obscures that very important fact.

In December, two Danish epidemiologists concluded that earlier studies of mammography were so poor that it could not be concluded that they save lives by finding more tumors earlier.

While it is true that breast cancer survival rates have risen in the last 20 years, better treatment, not earlier diagnosis, might be the reason. Doctors can't say for sure.

I have this vision of women listening to every word uttered in these scientific squabbles and wringing their hands over whether to expose their breasts to the radiation of a mammogram. And all the while, their cholesterol levels climb silently through the roof.

But that is how we seem to manage health care in this country: The squeaky wheel gets the grease.

Every year, the American Heart Association calls and asks me to mail 10 preprinted solicitation letters to my neighbors, to which perhaps two respond with donations.

And every year, thousands of women run through the streets of cities everywhere raising money for breast cancer research.

We appear to assign medical research dollars in this country based on some kind of media-driven popularity contest. Why don't we just turn the whole business over to People magazine and be done with it?

We don't know what causes breast cancer, but we know what causes heart disease. We don't know how to prevent breast cancer, but we know how to prevent heart disease.

And we don't know how to cure breast cancer - we whale at it with knives, poison and radiation - but we know how to manage heart disease.

You could argue that those facts make the case for the emphasis on breast cancer research, but you would be wrong.

If we have such a handle on the No. 1 killer of women, why is it the No. 1 killer of women? Why aren't we having a huge public conversation on the need for cholesterol screening and stress tests?

Why do women examine their breasts in the shower every month but ignore the pains in their chests until it is too late to save them from a survivable heart attack?

Heart disease kills more women than men each year - about 500,000. By comparison, breast cancer kills about 40,000. Women are more likely than men to die within a year of their first heart attack, and they are much more likely than men to have a second one.

Each year, 190,000 new cases of breast cancer are detected, but more than 50 million adult women have cholesterol levels above 200.

Breast cancer is not even the leading killer cancer among women: Lung cancer is.

The medical community can't say for certain that a mammogram will save your life - the breast cancer it discovers may be aggressive enough to kill you no matter when it is discovered.

But those same doctors can say with certainty that diet, exercise, lifestyle choices like not smoking and moderate drinking, and medication can control heart disease in most patients.

In an open society like ours, we are bound to overhear hair-splitting medical debates like the one going on now about mammography. It is only a problem if the uncertainty about the benefits of mammography causes us not to act.

I have had a mammogram every year since I turned 40 and I will continue to do so because, let's face it, the thought of breast cancer absolutely terrifies me, as it does so many women, and mammography is the best diagnostic tool we have right now. I'd consult the Ouija board if I thought it would tell me what a mammogram tells me.

But I am uneasy with the dollars and the media attention this disease gets because it points to an underlying defect in the way we assign our medical resources in this country.

The fact that half the population is terrified of losing a breast isn't a sensible reason to focus on breast cancer to the detriment of other, more deadly, diseases to which women are vulnerable.

The U.S. Preventative Services Task Force, which appears to have the final word in such matters, still says women should get mammograms every year or so after the age of 40.

What this means in real terms is that, despite the equivocation in the medical community, insurance companies will continue to pay for our mammograms for the foreseeable future, even though there is no conclusive proof of mammography's effectiveness.

But it does have merit as a diagnostic tool, and women should take advantage of any such tools in guarding their health.

That goes for heart health, too.

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