A misguided bill pushing for earlier breast cancer screening

Rep. Debbie Wasserman Schultz (D-Fla.) this week announced that she had her breasts and ovaries removed after finding a lump, having surgery, then learning she was at greater risk because of her Ashkenazi Jewish descent. She’s only 42, mother of 3. The Washington Post covered the announcement.

My heart goes out to Rep. Wasserman Schultz. But she doesn’t get my support for her new bill.

The Post said she announced “legislation for a national campaign to educate the public, particularly young women and their doctors, about the need for a much earlier approach to breast cancer detection. The accepted standard of mammograms at age 40, advocacy groups say, creates a false sense of security for younger women. Other cancer survivors, some in their 30s, came to the Hill to ring the alarm, to applaud Wasserman Schultz for going public and to cry with her.”

It’s unfortunate that the Post didn’t specify which advocacy groups push for younger screening because not all do. The National Breast Cancer Coalition sent its analysis of the proposed legislation to the Hill yesterday. Excerpts:

“Unfortunately, the bill at issue is based on several false premises, contains incorrect information, and will not achieve (its) goals. The bill is addressed to a population of women in whom breast cancer is exceedingly rare, and presumes we know what to tell these women about prevention, risk reduction and early detection. We do not. If we believe a public campaign to this population is important, we need scientific inquiry to find the answers to these questions before we launch any public campaign.

Our concerns center on the following:

1.) That breast cancer in women under 40, an admittedly rare occurrence, necessitates a broad public health campaign and education in secondary schools and universities;

2.) That we know what women should do to prevent or lower their risk of breast cancer;

3.) That breast self examination and clinical breast examination are effective in saving lives in this age group;

4.) That ethnicity is sufficient to trigger genetic counseling and testing

5.) That there are significant differences in what we know and what we should tell women under 40 years old versus over 40 years old.

What this bill contemplates is a nationwide public health campaign that will reach out to millions of women with a message that may be misleading in some instances and pertinent to a tiny percentage. The important nuances of the issues will not be captured in this type of campaign, and will result in more harm than good.”

One of my blog readers – a woman with deep interests in health topics -wrote me about this:

“This is a very typical scenario, unfortunately. Someone who suffers from a disease, or whose family member suffers from it, jumps into advocacy without knowing what they are talking about. To make matters worse, everyone feels so sorry for them that if you criticize the policies they are advocating it makes you look heartless.”

So get me straight on this: I am not heartless and offer my sincere best wishes to Rep. Wasserman Schultz. But advocacy of non-evidence-based screening has been shown to carry more harm than good. And to my own Senator, Amy Klobuchar (D-Minn.), who is co-sponsoring the legislation, I can only say that I am disappointed.

If you believe in rational health care reform, you cannot support legislation that will result in many false positives, many more diagnoses of the precancerous lesions that may not go on to create any problems, much anxiety in young women who are now labeled with something they don’t know will harm them, and – last of all – higher costs.