The first half of my medical career was spent in the antiseptic, brightly lit operating room and the sterile environment of the research laboratory. I believed and still do that science would make us all healthier when vigorously pursued. But over time, I learned that no discovery has any value if not communicated in a way that is easy to understand and act on, but also impresses upon the patients that they are cared for and we are acting in their best interest. The recent changes in women’s health have been positive, but there has been too little recognition that if medicine and government cavalierly tear down former pillars such as Pap smears and mammography, there is a perceived lack of safety that accompanies the announcements.
The recent rethinking of many of the old adages in women’s health is sweeping. Because of their rapid and drastic departures from conventional wisdom, many of the new views on mammography, Pap smears and even hormone-replacement therapy are understandably inducing anxiety among women who had previously been led to believe that routine aggressive screening can reduce their risk of breast and cervical cancer.
When the new mammography guidelines recommending biennial screening beginning at age 50, not 40, were issued by the U.S. Preventive Services Task Force in 2009, I immediately kicked our team into overdrive to get a show on the air to explain what that meant. We developed a show that had the leading experts in breast cancer review criteria women needed to consider. We didn’t do anything that the task force hadn’t done in its analysis, but we did have the necessary extended discussion about what anxiety such a new approach would invoke and how to process such a change without driving yourself batty with confusion.
Writing and hosting that particular show was a turning point for me because I learned that while real, meaningful metrics help us make better determinations of risk and is a critical way for science to self-correct, that wasn’t the discussion that needed to take place. What needed to be discussed was how women could come to terms with a perceived sudden vulnerability. Each woman has her own unique story, risk factors, family history and feelings. To separate the two nullifies any progress made through data discovery and impedes translation of new knowledge into a new paradigm of care.
Once diagnosed, physicians work with patients to alleviate disease by any ethical and safe means. Preventive screenings, however, are much more ambiguous. Screening and prevention are about healthy people trying to avoid becoming sick, and the data is often inconclusive. While certain risk factors are well understood, the dark reality is that we often don’t know whether widespread general application of many tests such as mammograms and Pap smears helps or hurts.
Each passing year we develop better drugs and imaging. We are exponentially learning how diet can help and hurt us. We are deciding on risk factors for disease based on decades of records. So too we must see the recent changes in women’s health as a positive evolution of our understanding of holistic healing for women — albeit a rapid, sweeping and poorly communicated one.
Let’s translate the same level of energy spent on research into communication of what our progress means to a woman in a practical sense, and the public-health impact will be immeasurable. We can never separate the fact that when you change a general guideline, you are also changing a person’s perspective on how much control they have over their health.
Pap-screening guidelines will someday be revised again. Fertility will be perpetually re-examined. New drugs will arrive for women’s cancers. Criteria for operating on breast cancer will change. The list goes on, and these things are good. But we must listen to how we sound to the women we seek to help. I learned to listen the hard way — thanks to the women in my life and on my show. The rest of medicine would be well served to do the same.