Tuesday, January 28, 1997
Breast cancer deadly test of health care

BY LAURA PULFER
The Cincinnati Enquirer

Breast cancer has done wonders for my reputation. For instance, a lot of people think I'm brave. I also get credit for surviving. Sometimes, they even assume I know something about medicine.

The only thing I know is that I'm glad I get my health care from a doctor instead of a bean counter.

Otherwise, I would be one dead bean.

My gynecologist nagged me to get a mammogram, even though I was in my early 40s, even though I was not statistically at risk, even though my insurance carrier wouldn't pay for it.

When I got the call from him, telling me my mammogram was ''bad,'' I remember being so terrified that my feet and legs were numb. That must be why they tell you to sit down. Brave. Ha.

Bitter debate

I'm scared again. Not about me. What I had, thanks to early detection, was Cancer Lite. Surgery, chemo and I live to tell the tale. (Over and over again, according to my friends.) But the latest advice to women is frightening.

A panel appointed by the National Cancer Institute (NCI) again failed to recommend mammograms for women in their 40s. A bitter debate ensued. Make no mistake about this debate. It is not about health. It is about money.

Breast cancer strikes about 180,000 American women each year and will kill 44,000 this year. But only 10 percent of them will be under the age of 50.

So, even though breast cancer is the leading cause of death for U.S. women ages 40-49, and even though some of the women who die in their 50s had the cancer in their 40s, this wimpy panel could not bring itself to recommend the most effective diagnostic test we have.

This same government will talk to us about air bags and tobacco and seat belts until our ears turn blue.

The ''consensus development statement'' from the NCI frets about the risks of breast X-rays including false alarms, which occur 10 percent of the time. There's a patronizing discussion of the ''inconvenience, anxiety and fear'' caused by a false positive.

Surely the inconvenience, anxiety and fear of finding out that you have cancer that began in a breast and has now spread to, say, your liver, brain and lungs is worse that discovering that you don't actually have cancer at all.

''This is nuts,'' says Dr. Donna Stahl, probably the best-known local expert in diseases of the breast. ''Breast cancer is potentially curable. And the earlier we can find it, the better chance we have.''

Or as one of the city's most highly regarded radiologists, Dr. Myron Moskowitz, puts it, ''The only way to find it early is to look for it early.''

The trouble is there are so many of us - and if they find something suspicious, they have to act. Then, maybe they have to order up more procedures - such as needle aspiration, ultrasound, surgical biopsy.

More expense.

And all that happens is that a few more women in early middle age will get to live.

Anxious and alive

Besides, ''earlier detection may cause additional months or years of cancer-related anxiety, affecting personal relationships, insurance coverage, and the workplace.'' The NCI report actually said that.

If finding out that you have cancer affects your insurance coverage, perhaps we should put some heat on the insurance carrier. And I am certainly pleased to pay the price of living with ''additional months or years of cancer-related anxiety.'' I hope I'm anxious into my 80s.

No wonder even the guy who set up the panel, NCI's director Richard Klausner, challenged its conclusions. It sounds as though he was hoping to reverse a 1993 government decision that there was insufficient scientific evidence to justify testing younger women.

They took a step in the right direction, but it was a baby step. They now say ''each woman should decide for herself whether to undergo mammography.''

We know what this means. Poor, uneducated, uninsured women will be less likely to ''decide'' to have this test. And they will get sick and die in greater numbers than women who have breast cancer screenings. They will be sicker longer.

Maybe Americans should decide that this is unacceptable. It would do wonders for our reputation.

Laura Pulfer's column appears in The Enquirer on Sundays, Tuesdays and Thursdays. Call 768-8393 or fax at 768-8340. She can be heard Monday mornings on WVXU radio (91.7 FM) and as a regular commentator on National Public Radio's Morning Edition.