My 44-year old friend Natalie looks great. She is half way through her radiation treatment for a malignant tumor found so far back in her breast no self-exam would have found it. Hopefully she’ll be able to avoid chemotherapy. She had no family history of cancer, no genetic or behavioral markers. It’s true there is no way of knowing whether this particular tumor would have killed her; some cancers are so slow-growing as to be almost non-threatening. Mammograms detect more thoroughly than ever any anomoly but even when something is found to be malignant, it’s not always possible to know whether it’s potentially fatal. Natalie doesn’t care and neither do her friends, frankly. At this level, the anxiety is more than worth it.
I understand the concept of “evidence-based science” as well as the next person. Reason demands evidence, at least when it comes to issuing absolutes. Too many people are inclined to make presumptive declarations — that is, declarations that presume knowledge. So yes, show me the evidence.
I also understand that our bodies are highly complex organisms with any number of uncertainties built right into them. There may be tumors and aneurysms, clogged veins and weakened livers, and even degenerative disks, none of which are necessarily going to harm us or even slow us down. Why find out if you’re caring a potentially threatening gene, some argue, the operative word being potentially? Life is about uncertainty; some things we can’t know; others we don’t need to.
But even though I get all that, even though I believe that we must all learn to live with uncertainty, even though I realize living involves risk and many kinds of cancer aren’t life-threatening, I cannot wrap my mind around what not being tested might have meant for my friend Natalie.
My difficulty with the recommendations has nothing to do with the politicizing of the findings, which are, after all, reissues of earlier recommendations. Trying to tie these recommendations to the “threat” of managed care is another deliberate attempt at fear-mongering. But I find the “small risk” argument to be an unpersuasive one: except for chemo, most women will tell you mammograms, sonograms, biopsies, anxiety, and even radiation are worth undergoing. Yes, evidence shows that only one in more than 1900 women’s lives were saved by early testing. But that one may have been my friend Natalie.