As we all know, recent recommendations about mammograms and Pap smears have caused some confusion among both women and doctors. I can understand at a time when we’re discussing cutting costs in healthcare and setting up death panels to kill old people, guidelines to reduce screenings can cause suspicion. Nonetheless, I was surprised that the discussions on my favorite blog (yes, even more than my own!) Feministing generally perpetuated that suspicion/outrage. I expected that feminists would be more skeptical of American healthcare and skeptical of the original mammograms guidelines to be so struck by the changes.
You can read more about the science behind the new guidelines here, and I’m sure in many other blogs. The whole point of revising the once-a-year mammogram rule is that it leads to a lot of over-treatment. Of course, screening too little would be under-treatment. Evidence based guidelines are always trying to find the happy medium, and yearly mammograms are not that happy medium. One author I read complained that the new guideline was not based on new studies, but faults of older studies that lead to the yearly mammogram rule. But if the yearly mammogram rule was based on flawed studies, isn’t that enough reason to question the guideline, especially when it leads to over treatment? A poster on Feministing had asked “how could reduced screening ever be a good thing?” Well, you have to consider the invasiveness and cost of the screening. X-ray imaging, which has more risks, and MRIs which are expensive, are done less often. On the other hand, self breast exams can and should be done more often. I wish the authors of the guideline had done a better job of explaining the reasoning. Instead of highlighting that yearly mammograms lead to unnecessary anxiety, which understandably made women mad, they should’ve made it more clear that previous guidelines were not based on the best evidence, and the risks of over treatment are greater than the benefits of frequent invasive screening. They should’ve also emphasized the importance of breast exams, by self and doctor. It would be useful to know other countries’ policies on this too.
I expected feminists to think about the above reasoning intuitively, given the context of women and healthcare. So I was surprised to see the notion that a right was being taken away, rather than questioning whether yearly mammograms were the best thing to do in the first place. Are we so naive to believe that existing healthcare practices on women’s issues are always in the best interests of women? Haven’t we discussed before that sometimes profit motives of pharmaceutical and biotech companies can interfere with evidence based medicine, and over-pathologize certain issues like PMS and reduced interest in sex, to create a market for drugs? And who can forget “designer vaginas?” Feminist theorists have pointed out that because we have historically considered the male body as the norm, many female bodily processes have seemed inherently pathological. While access to birth control is definitely a positive thing for women, some feminists have also noted the sexism in the drive to regulating women’s fertility with drugs and devices, as opposed to researching birth control on men. For social reasons, women’s bodies are more tampered with on the aspects where women are different from men. In America especially, where healthcare practices are heavily influenced by profit and inequality of access, we tend to have widespread use of technological and pharmacological interventions on women’s bodies, from interventions during labor, C-sections, hysterectomies, pills for PMS, PMDD, etc, etc. It’s not that such high use of gadgetry is unsafe, but it’s not based on scientific recommendations or medical indications either. In countries with more socialized healthcare, cost-effectiveness is always an issue, so the necessity of pills and surgeries are under more scrutiny. I’m not saying that previous mammogram guidelines were based on biotech companies wanting to make more money. I’m saying that given the context of American healthcare, guidelines for less use of gadgets is likely to be a good thing, as the norm for us is usually overuse and waste. Has our widespread use of invasive medical procedures led to much better outcomes for American women? Not really.
I realize that the mammogram issue is different for two reasons, 1) it’s not really in the realm of reproductive health where inequality is clearer, and 2) it’s because of feminist activism that breast cancer awareness and prevention has become such important issues in the first place. Once upon a time, breast cancer research was actually being done on men (!), who comprise a small minority of breast cancer patients. It has been a huge success of feminist activists to shed light on a disease that affected and killed women (for the most part). Breast cancer awareness, screening, and treatment have saved many women’s lives.
But as feminist activism changes society, feminists have to deal with new issues of a new society. Nowadays, breast cancer awareness is so commercialized that merchandise is ubiquitous. Community posts on Feministing have pointed out the sexism in using breast cancer campaign slogans like “Save the Tatas.” It seems now that feminists have legitimized the threat of breast cancer, the interest in the issue is becoming a little sensational. After all, it is about boobies, not non-sexual things like cardiovascular diseases (which kills more women than breast cancer) or colon cancer. So I think we feminists need to take a step back from the notion that fewer mammograms mean that the scientists don’t care about women dying from breast cancer. It just means that as far as we know, fewer mammograms will reduce over-treatment yet not reduce survival rates. This is also an opportunity to think about how breast cancer isn’t women’s only health issue. Let’s start focusing some effort on cardiovascular health, which is also an area where we need more women-specific research.