The Hidden Risks of Women’s Preventative Health Care

For most of my life, I’ve followed doctors’ recommendations for preventative healthcare. I started getting annual PAP smears before I was even sexually active. (That’s my story and I’m sticking to it.) Dentists have regularly cleaned and x-rayed my teeth in search of cavities I can’t see or feel. Though my vision hasn’t changed since I was a teenager, I’ve (clearly) seen my eye doctor every year. Dermatologists have transformed my suspicious looking freckles into scars. I spent hours (more like weeks) waiting at prenatal appointments during each of my four pregnancies. Repeat blood work shows that my thyroid still works and that my cholesterol is still low. I’ve had sonograms, mammograms, biopsies, CT-scans and MRIs. Anything covered by insurance seemed like a no-brainer and a win/win. Preventative healthcare is a privilege. Participation is required.

For someone who’s never been seriously ill, I’ve had a lot of medical interventions. Why does good health seem to require so much health care? Why do we go to the doctor when we’re not sick? Is all of this really necessary? It seems prevention is more about tests and procedures these days than a healthy lifestyle.

When I look at the big picture, the reality (for me) is that for every concern I’ve brought to a physician, just as many have arisen as the direct result of a preventative healthcare screen. I’ve spent a lot of time and money (with bonus side effects and stress) on follow up tests and procedures deemed necessary after a wellness check. And I’ve started wondering if I’d be any less healthy (and maybe even better off) if I only went to the doctor when something was wrong. Wellness, by definition, is independent and sustainable. Preventative healthcare, on the other hand, is a very lucrative business. 

Consider my story. Last year, my doctor’s office sent me a scathing reproach when I declined to schedule my annual PAP smear. A letter arrived by certified mail (requiring my signature) warning that I might be dropped from the practice due to this serious insubordination that significantly compromised my health. Since when does missing an annual visit increase the risk of cancer? The notice left me feeling fearful and stressed, as though I was a reckless and irresponsible person (patient).

The reason I opted to forgo the suggested (just kidding—evidently it was mandatory) appointment was because the prior year, abnormal PAP results had led to biopsy and surgery. Even at the time, these precautions felt unnecessary. I knew in my gut there was nothing wrong. And I was right. Everything was fine in the end. You see, I’ve gone through this before. Almost every biopsy I’ve ever had for any reason has revealed the presence of “abnormal” cells. Evidently, I’m an all-around “atypical” person. I don’t think this makes me high-risk (though I’ll admit to being high-maintenance). Unfortunately, the typical care for my atypical results has been invasive and painful.  

I live an atypical, anti-cancer lifestyle. My diet is based on organic, plant-based, unprocessed foods. Wearing homemade deodorant and organic make up reduces my exposure to toxic chemicals. Sleep, exercise and deep breathing are top priorities for me. I pay attention to my body. When there is a problem, I look for the cause as the cure rather than relying on drugs that suppress symptoms. But subjecting myself to medical procedures when there was no reason to think anything was wrong has not proven beneficial.

Our immune systems are designed to eliminate cancer. The body produces 50 million new cells every second. The rate of error during replication is about two percent. That means that every day, the immune system must destroy one million cancerous cells before they proliferate. Most cancers are stopped before they start. Many disappear on their own. (1) Tests and interventions that damage and interfere with immunity increase the risk of disease rather than diminish it. 

But we live in a fear-based, instantly gratified society, and I’m not immune. I had avoided my preventative healthcare appointment for a year and my confidence wavered when they called to schedule me again. I decided it couldn’t hurt to check in with my doctor, especially now that I’ve started experiencing the oh-so-fun symptoms of peri-menopause. I figured a blood-draw to establish my base hormone levels would be helpful in the event my self-prescribed black cohosh supplement and progesterone cream lose their effectiveness. So I made the appointment, plugged my feet into the stirrups and hoped for (at least) some stimulating conversation to offset the intrusion. 

My concerns about my body and my age did not come up, however. Instead, we discussed my doctor’s thoughts on mammograms and colonoscopies. There was no time spared to talk about diet, exercise, sleep, my sex life or general well being. The litany of preventative tests recommended for my age group was the main focus. 

Discussions about night sweats, vaginal dryness and the normal mid-life homicidal ideations (or is that just me?) were preempted as I defended my reasoning for not getting another mammogram anytime soon. I’d done my homework and was prepared. It’s soothing to believe that early detection of breast cancer outweighs the risks of radiation. But 70-80 percent of detected “tumors” seen on the mammogram do not end up being cancer. False positives lead to invasive biopsies, mastectomies, chemotherapy and radiation, not to mention severe emotional trauma. Just as bad are the false negatives. Mammograms don’t catch everything. One in five malignant tumors are missed by mammography.(2)

There’s more. Early and regular exposure to the radiation increases the risk of disease. That’s a fact. And the compression of the breast during the mammogram can help spread existing cancer cells, allowing them to metastasize from the breast tissue. Women who are genetically predisposed to breast cancer carry the highest risk (which calls for more mammograms, not less).

My doctor did concede that mammograms aren’t a catch-all. I was informed that there are aggressive breast cancers that can arise and metastasize between regular screenings. And, there are also slow growing cancers that will never cause symptoms or become life-threatening. In the later case, the “cures” (preventative chemo and radiation) kill more people than the disease.  

The mammogram was still formally recommended, however (and my polite decline was carefully documented to ensure all asses bases were covered). It was clear that the official standard of care does not include reducing preventative healthcare –especially if it’s covered by insurance.

At the conclusion of the appointment, my doctor mentioned how lucky I was that last year’s biopsy and surgery had not resulted in a hysterectomy. “We want to avoid that at all costs.” Um, yeah. Me too! But how much of my good health is “luck” and how much is within my control? That offhanded statement brought a startling realization: if (and when) atypical cells are found, I might find myself in the operating room once again and lose the battle of rights over my own organs.

Since that appointment, I’ve learned that the CDC now recommends PAP smears only every three years. Evidence shows that more frequent screening does not detect more cervical cancer. Philip Castle of the American Society for Clinical Pathology cautions, “If you test every year you find a lot of benign infections that would go away on their own. You end up overscreening, overmanaging and overtreating women who are not actually at risk of getting cervical cancer.” (3)

 As for mammograms, a twenty-five year follow up study of 90,000 women found there is no advantage to finding breast cancers when they are too small to feel. Self-exams are as good as or better than regular mammograms at locating the serious cancers that need treatment. (4) Think about that. If there’s no benefit in discover cancer before we can feel it, why are mammograms pushed upon all women with such life-or-death intensity? If my doctor is aware of this study, how and why are regular mammograms recommended?

There are many people who have undoubtedly benefited from cancer screens. But studies and statistics show there are also many people who have been the victims of the system. No one can know what might have happened had they not known or opted out. Regardless, everyone’s battle with cancer is terrifying and courageous. People who survive diagnosis and treatment have earned their place as a hero with blood, sweat and tears. And doctor’s are doing the best they can to treat us given the information they have. But where is that information coming from besides companies that profit from all of it? I struggle to even admit my skepticism on this topic as I’ve never had a cancer diagnosis and it feels sacrilegious to question the system that appears to have saved so many lives. No one wants to imagine that they might have been one of the false positives and undergone unnecessary treatment, or that if they live to see five more years, it’s the chemo and radiation they survived, not the cancer.

As difficult and emotional as it is, we have to ask these questions. The bottom line is that cancer screenings and treatments net billions of dollars for Big Business. There is no profit to be made on people who are independently well. But my breasts, uterus and cervix aren’t healthy because of invasive preventative healthcare. They are healthy because I take care of them. If something is ever wrong with my body, I won’t need someone to tell me. I pay attention and recognize when something isn’t right. If good food, extra rest and self-care don’t return my body to balance, then I’ll listen to my intuition. I’ll seek help when I need it–not before. 

(1) http://www.nytimes.com/2009/10/27/health/27canc.html

(2) https://www.cancer.gov/types/breast/patient/breast-screening-pdq – section/_43

(3) http://www.reuters.com/article/us-cancer-cervical-uspstf-idUSTRE79I0RZ20111019?feedType=RSS&feedName=healthNews

(4) http://www.bmj.com/content/348/bmj.g366