Mammography screening
The article on the mammography screening debate (“2 sides of the screening debate,” Sept. 25, by Tribune reporter Julie Deardorff), correctly points out that the problem with mammography screening, with which most women are familiar, is the anxiety brought on by false positive results that may require repeat mammograms and occasional biopsies.
Deardorff only briefly touches on the far more important potential harm of screening mammography: that it “can also flag disease that would never have been a problem, triggering a cascade of potentially unnecessary treatment and anxiety.”
She is referring to over-diagnosis, primarily involving the entity of precancerous ductal carcinoma in situ (DCIS).
Prior to the advent of screening mammography, DCIS constituted less than 5 percent of breast tumors. However, because DCIS is readily visible on mammography by its speckled calcifications, it now currently represents 27 percent of diagnosed breast cancers annually. In 2012 the American Cancer Society estimated the total number of breast cancers diagnosed in the United States to be 234,580, of which 64,640 were DCIS. The actual percentage of DCIS cases that progress to invasive breast cancer is not known with certainty, but most researchers estimate it to be in the 50 percent range. The other 50 percent of women with DCIS will never experience any adverse effect of this condition, even if left untreated.
The real problem is that because there is no way to determine which DCIS patients will go on to develop invasive cancer and which will not, all of these 64,640 women — including the 50 percent of women with DCIS who will never develop invasive cancer — will have to undergo treatment ordinarily consisting of surgery, chemotherapy, radiation or combinations thereof.
There are three types of cancer: those that are so virulent that no matter when the diagnosis is made, the patient will unfortunately die of the disease; those that are so benign and indolent that patients will live their lives without any adverse effects of the cancer; and those where the likelihood of cure is indeed better when the diagnosis is made early. Screening mammography is clearly beneficial in the third group. It is neither beneficial nor harmful in the first group. It is harmful, however, in the second group, into which most women with DCIS fall, because women will be unnecessarily subjected to treatment that could be injurious for a “cancer” that never would have caused injury in the first place.
Every physician and researcher today would agree that women should educate themselves by reading as much as they can about all the facts regarding benefits and harms of screening mammography. Two books, among others, that explore these questions and issues in depth and in layman’s language are “Overdiagnosed: Making People Sick in the Pursuit of Health” by internist H. Gilbert Welch and associates, and “The Big Squeeze” by radiologist Handel Reynolds, are of great value in providing this education. Women of all ages should then discuss these issues with their physician.
— Dr. Leonard Berlin, Wilmette
Insurance costs
In early August my boss called me into his office and said, “I’ve got bad news and good news for you. The bad news is, the deductible on the new health insurance contract has increased 40 percent. The good news is, the premiums only increased 20 percent. We took two months to research this, and this is the best we can do.”
So now my deductible is $3,500 per person instead of $2,500. But my premium costs, my costs, not my cost and the company’s cost, is only 30 percent of my before-tax salary. And, while it is only inches away from being a Cadillac premium, my current policy doesn’t have prescription coverage, it doesn’t cover most preventive examinations and it doesn’t cover those $25 immunizations we can get at Walgreens.
My wife works, otherwise we would have to choose between health insurance or eating and living indoors.
My question is, then, why are certain legislators against the Affordable Care Act, other than their base salary is $174,000 before perks, all paid for by the taxes on people they deem undeserving of affordable health care?
— Fred Lierman, Rockford
Health care law
“If you like your health insurance you can keep it.”
Sound familiar?
I recently received a letter from my insurance company that my policy will not be renewed due to the new health care law. I can now join the others in searching for insurance.
But I thought I could keep mine!
Do the lies ever end?
— Teresa Zambole, Berwyn
Imperfect solution
If perfection were a prerequisite for the rollout of any program, we would be precluded from virtually all great advances. Obamacare, the Affordable Health Care Act, won’t be perfect, but we’ve come to the logical and moral conclusions that everyone in our country should have access to at least minimal health care, and we can’t afford the inefficiencies and ineffectiveness of our current system.
To facilitate this change we need to embrace an imperfect but well-conceived and long overdue attempt to correct the situation.
— Del Bloem, Inverness
Homosexual children
This is in response to “Why same-sex marriage would be bad for Illinois” (Commentary, Oct. 4), by Jocelyn Floyd, special counsel for the Thomas More Society. Floyd’s main argument is that it is society’s responsibility to protect children.
I embrace Floyd’s belief that children are the key to our society’s future, and we must protect them. However, as a therapist who works primarily with adolescents, I noticed that Floyd neglected to address the needs of one group of children: those who discover they are homosexual.
Lesbian and gay adolescents live in a culture in which they are faced with homophobia on a daily basis. This takes a significant emotional toll on developing adolescents, making them at risk for a host of mental health problems. They are additionally harmed by the continuing lack of marriage equality in Illinois. Knowing they have a future in which they may not legally marry, with the same rights and privileges heterosexuals enjoy, intensifies the pain of living with the denigration they must endure.
It is time to send a positive message of support to gay and lesbian adolescents in Illinois: You are valued members of society, and you deserve the same rights and respect as heterosexuals.
— Nancy Fielding, Downers Grove
