Yet the stakes in this controversy are just as high for me (and women like me) as they are for women in whose lives cancer is only a threat rather than a reality.
As we have been told, the issue is a complicated one. On one side, organizations such as the American Cancer Society and the Susan G. Komen Foundation point out that deaths from breast cancer have decreased since yearly screenings for over-40s became the norm. While they acknowledge some methodological flaws in previous studies, these groups see no sense in throwing the mammogram baby out with the biostatistical bath water. On the other side, organizations such as the National Breast Cancer Coalition and Breast Cancer Action (backed by Danish researchers) argue that the studies' flaws invalidate such findings and that yearly screening can lead not only to unnecessary emotional anxiety but also to unnecessary medical treatments.
To my mind, the mammo-skeptics have a point. Mammography is not a silver bullet. It's actually more like buckshot: results are scattered and therefore unreliable; more damage is sometimes done than intended. Dependency on mammograms is also dangerous beyond its ability or inability to catch all breast cancers. It discourages women from taking responsibility for their own bodies. Women over 40 who get yearly mammograms may be lulled into thinking they don't have to do monthly breast self-exams or pay attention to their bodies. The mammogram will catch it, right?
While these dangers are compelling, a potentially larger danger lies in the way the controversy is being fought in the media. Most op-ed pieces and medical articles - no matter the position of the writer - conclude "every woman should assess the advantages and disadvantages of mammography and decide for herself." Unfortunately, most women don't feel competent to assess this debate. And why should they?
On one side are arrayed breast cancer survivors, clinical physicians, and researchers. On the other side, we find . . . well. . . exactly the same demographics. Each side claims to have, if not God, at least personal experience and medical authority on their side. Whom do we believe? And more important, how do we determine who wins?
Unfortunately, the "winner" in this controversy is not likely to be found among constituencies on either side of the mammography debate. It will instead be the health-insurance carriers who win because the controversy casts doubt on the "medical necessity" of yearly mammograms. No medical necessity, no coverage of yearly mammograms for women of any age. For all its scientific goodwill and impassioned advocacy, this controversy may end up freezing out women who feel unable to enter the debate at any level; if this happens, many decisions will likely be made for us. Medical decisions will be taken out of the hands of individuals and put into the hands of corporations. While mammo-skeptics raise important medical and social concerns, there is a danger that their message of individual agency and choice will be co-opted by insurance companies uninterested in either.
To both sides of this debate, I say: Argue if you must, but follow the money. Keep an eye on who is funding studies that undermine the efficacy of mammograms, and conversely, on the potential corporate polluters who fund studies of mammography while allowing studies on the links between breast cancer and environmental carcinogens to go unfunded. To the mammo-skeptics: If you are going to purvey doubt, at least give us some suggestions on how to handle the doubt. If we can't take medical action, what political action can we take?
But most of all, to the women watching this debate, I say: Stick with it. When medical authorities say, "There is doubt about the efficacy of mammograms," don't automatically hear "The sky is falling," or worse yet, don't just change the channel. If you don't decide this issue for yourself, someone else may decide it for all of us.
Kellie Robertson (krobert@pitt.edu) is an assistant professor of English at the University of Pittsburgh.
