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Carly's Cancer Warning
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The new breast cancer advice “defies common sense,” says Carly Fiorina. The California Senate candidate and former HP CEO, still recovering from her own grueling battle with the disease, talks to Dana Goldstein.
Carly Fiorina, once the most powerful businesswoman in America and now a Republican candidate for the California Senate seat now held by Barbara Boxer, no longer sports her trademark, playful blond pixie cut. Fiorina learned she had breast cancer last February and underwent surgery in March. Just a month after finishing chemotherapy in early October, she announced her Senate run, hitting the campaign trail with a stylish buzz cut. So when the U.S. Preventive Task Force, a government-appointed panel of medical experts, announced Monday that it no longer recommends routine mammograms and breast self-exams for women under 50—and that even women over 50 should have the procedure only every other year—Fiorina, 55, had a lot to say. Had she followed those guidelines, “I’m not quite sure I’d be alive today,” Fiorina told The Daily Beast.
“I discovered my own lump two weeks after receiving a clear mammogram. So had I not been in the habit of self-examination I doubt I would have found it.”
The former Hewlett-Packard CEO, still recovering from her grueling nine-month battle with the disease, talked to The Daily Beast about how she found her own breast cancer through a self-exam, her strong opposition to the panel’s recommendations, and how it relates to the health-care reform battle in Washington. “It’s clear from my own experience and the experience of millions of other women that this new recommendation is not going to save lives,” she says.
What was your reaction to the new recommendations on mammograms and breast self-exams?
I was really shocked and disturbed because of my own personal experience. I discovered my own lump two weeks after receiving a clear mammogram. So had I not been in the habit of self-examination, I doubt I would have found it. And had I been following these recommendations, I would have waited a whole two years for my next mammogram, and I’m not quite sure I’d be alive today.
Following the outcry from many breast-cancer survivors after this news broke, Health and Human Services Secretary Kathleen Sebelius advised, “Keep doing what you have been doing… talk to your doctor about your individual history, ask questions, and make the decision that is right for you.” How do you interpret that, politically?
I think it’s a very confusing signal to send for women; for a task force that’s been pulled together by the government to come out and say one thing—which so flies in the face of everything women have been taught—and then, the next day, have the secretary of Health and Human Services say, “Oh, we’re not paying any attention to it.” At the very least, it’s confusing. At the very greatest, it suggests that this may be what happens when you have panels of so-called experts debating how to lower the costs of health care without considering what it does to the quality of health care.
Some people would say, “Well, these cancer screening tests are expensive, and they only save a very small number of lives in that 40 to 50 age range.” How can we balance concerns about public health costs while respecting the fact that many survivors feel they owe their lives to a mammogram?
Well, I guess what I’d say is that in my experience in business, the best way to reduce costs is actually to focus on quality. There are many things in a patient’s care—something I know a lot about, having just gone through breast cancer—that don’t improve care and are clearly costly, like repeating the same tests over and over again. I mean, when I was going to have my chemotherapy infusions, my blood pressure would be taken five or six times. That’s costly.
On the other hand, a test that clearly detects cancer and can save lives is something we shouldn’t be cutting out if we’re focusing on patients’ quality care.
And of course, beyond cost, this is a very emotional issue.
Well, one in six women now are diagnosed with breast cancer. You can’t tell me that diagnosis rate—and early diagnosis is key—hasn’t been improved by self-exams and mammograms. It defies common sense. It defies common sense to say that women shouldn’t be vigilant about their own health, through both self-exams and regular mammograms. And that’s why I think it’s emotional, because women know how common breast cancer is. How curable it is—caught soon enough—and how deadly it is if ignored.
Does government have a role in helping people to understand new medical research, in this case, findings that mammograms—while life-saving—may not be quite as effective for all women as initially thought?
I think government does not have a role in helping patients decide what their care should be. I think that role should rest with the doctor. If government has done research that is relevant, they should put that research out there to doctors and the public. But it’s not government’s role to then, as this task force did, recommend changes in care. They are overstepping their role. And that’s why so many women are concerned.
Many insurance companies deny coverage to breast-cancer survivors. One of the goals of the health-reform legislation in front of Congress right now—which you’ve said you oppose—is ending that practice. Should insurance companies be able to deny coverage due to preexisting conditions?
No. And that’s why I’m a supporter of health-care reform that solves the problem. You’re absolutely correct that the denial based on preexisting conditions impacts women harder than everyone else. There are very targeted ways to solve that problem, but it is not solved by having government run health insurance.
What are some of the policy changes you’d recommend?
One would be providing choice and competition among health-insurance plans. Another would be to specifically incent or subsidize companies so they would continue carrying people with preexisting conditions. I absolutely agree that all Americans should have access to quality, affordable health care, and women in particular. But the health-care bill wending its way through Congress doesn’t solve this problem.
Dana Goldstein is an associate editor and writer at The Daily Beast. Her work on politics, women’s issues, and education has appeared in The American Prospect, Slate, BusinessWeek, The New Republic, and The Nation.
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vulgrin
She lost me at the first answer:
"I was really shocked and disturbed because of my own personal experience. I discovered my own lump two weeks after receiving a clear mammogram. So had I not been in the habit of self-examination, I doubt I would have found it. And had I been following these recommendations, I would have waited a whole two years for my next mammogram, and I'm not quite sure I'd be alive today."
So, in other words, do your own self-checks - you don't need a mammogram. Her mammogram didn't pick up the lump and thankfully her self-check did. This means to me that the recommendation is correct - that yearly mammograms don't lower the rate of cancer deaths - and that instead we should be teaching women how to do their own self checks.
kscr14
Everyone is different. Some find it by mammogram and some find it by self checks.
devilsadvocate
No kidding. There's more than one way at prevention and detection.
Myshadow
Well, that is the way it is. My ex wife, who is a nurse, literally had the same experience, a clear mammogram and two weeks later felt a discomfort laying in bed.
In premenopausal women, the breast tissue is denser and mammograms don't detect carcenomas.
The sick thing is ultrasound is not part of the protocol for premenopausal women, yet that is how they initially confirmed what she had was cancer.
We are now 10 years past that now and healthy but, we became very aware how inadequate the system was/is then.
Women should have an ultra sound check, if they are under 50.
Leesby
And my cancer was found when I was 38 by mammogram, not palpable on physical exam. Fifteen years later, I have not had a reoccurance.
Only your doctor can advise you as to whether you should have scans of any kind. And that's based on your breast density and size, regardless of age.
Generalizations in any health care hurt everyone.
cathaleen
as a registered diagnostic sonographer I must say, ultrasound is a targeted exam, we are not good at screening the breast, but are good at examining specific lumps or masses that either the patient or doctor has palpated or areas seen on a mammogram.
Ultrasound, does not see all breast cancers, same as mammography does not see all breast cancers. But with a palpable lump in younger women, often ultrasound is step one, then mammography as a step 2 option.
Another development in breast imaging for younger women, is digital mammography which is still relatively new, but it does offer better visualization in the pre menopausal breast vs traditional mammography, so it may be worth tracking down this modality if you are a younger women facing the mammography question.
The best way to proceed is information, information, information.
Our clinic does screening and diagnostic mammography, and we have seen too many women in their early 40's dx with breast cancer to turn the clock back to the age of 50. Go annually and don't be dissuaded, in Canada, our screening program has coincided w/ the drop in cancer deaths...this is happening for a reason. And don't be afraid, fear of breast cancer can keep you from the annual exams you need......but having these exams will save your life!!!
kleighvines
Thank you! That statement bothered me the whole way through the article. She disproved her own argument for the need of mammograms every year and she doesn't even realize it.
devilsadvocate
Yet the same panel that recommends putting off mammograms until 50 also recommends that self exams be avoided. No logic in that.
This comment has been removed by The Daily Beast's editors.
johnmcenroe
Also, being an ex cancer patient doesn't suddenly make you an expert in the field.
Jaygim
It doesn't necessarily, but being a former caretaker of a cancer survivor, it sure as heck makes you vigilant about taking ownership and doing your own research. Why would I trust a cretin congress and senate to do that for me?
mindlessmissy
Being a former news parser, I do NOT recall when a "cretin congress and senate" [sic] making ANY such decisions for you ...
And IF you do not catch my drift, the Senate is PART of Congress ...
Also the new guidelines are NOT from congress ...
Jaygim
Thanks for your parse. And since you do so carefully, my use of the pronoun "that" didn't refer to "making ANY such decisions." It referred to my previous sentence, which mentioned taking ownership, doing your own research the best you can, et al. I never talked about "decision making" so your extraction -- while tempting and juicy to do (your thought I bet: hmm, here's another death panel blowhard) was incorrect. Oh and sorry about my faux pas about congress and senate. I should have re-written as Congress/Senate, which I assumed you would've guessed as simple metonymy for big G. But had I done so, you wouldn't have had the fleeting pleasure of parsing.
margiem
Stephanie Spielman died yesterday at age 42 of breast cancer after discovering her cancer at age 31. I've know 3 women who've died of breast cancer before age 40. These new guidelines are insane.
crymeariver
Then why don't we don't we start testing women from birth to death? You cases are sad but they are rare. Only 1 out of 1,900 women screened by mammograms are found to have cancer. Why not start at age 12, that way we can just kill women through the excessive radiation exposure and excessive biopsies!
sophia5
" The new breast cancer advice "defies common sense," says Carly Fiorina. "
When has government been synonymous with common sense ?
A U.S. government group made this recommendation.
The U.S. Preventive Services Task force (USPSTF).
" Task force " . . . sounds fancy for PANEL.
Is this a peak into Government run health care ?
I'll take the advice of personal doctors over
a panel of ANONYMOUS ( ? ) government " EXPERTS "
telling the rest of us what is good for us.
No Thanks.
Best wishes to Ms. Fiorina.
cbeenthere
Well, sophia, that is EXACTLY who put these recommendations together, an independent panel of doctors from universities and teaching hospitals ie.Georgetown University Hospital. You can't get much better advice than that. For those who don't have the advantage of being treated at these well funded institutions of higher learning, this sharing of knowledge provides an important aspect to health care, and we should be grateful for that.
sophia5
. . . and for all those women who caught cancer in their 20's, 30's, and 40's this recommendation to wait is insane.
On the heals of the crazy mammogram announcement comes this new one today:
The American College of Obstetricians and Gynecologists issued new recommendations today advising women not to be screened so frequently.
LINK:
http://health.usnews.com/blogs/on-women/2009/11/20/get-your-pap-smear-to -screen-for-cervical-cancerbut-less-often.html
Both ideas sound like money saving tactics (rationing) just in time for Government Run Healthcare.
Women should be allowed to make individual choices with their individual doctors on how many times they would like to get these tests. NOT SOME GOVERNMENT AGENCY.
Sure we have our healthcare system problems in this country,
but no country on the face of the earth has better
screening and cancer research than the U.S.
http://www.youtube.com/watch?v=FeFd51JJEkc
Olivia Newton Jon went on further in the interview to say we are going backwards . . . to where some
European countries are on GOVERNMENT LIMITED screening.
Is this the government's way of " NUDGING " us toward
a healthcare system run by " Expert Government Panels? "
Don't be shocked if down the road these " recommendations "
become " enforced " . . . LIMITED by government.
crymeariver
Sophia,
that panel has been around for DECADES and is the reason we have both the CURRRENT screening guidelines for all types of diseases. Do you also have a problem with their recommendations on heart disease, hypertension, prostate cancer, lung cancer, etc.... They have been doing this all this time and you pick NOW to grandstand?
sherrycnm
Please educate yourself! Your uneducated/uninformed views are dangerous. We have known for 10 years (To Err Is Human) that some 100,000 Americans die from mistakes EVERY year in our hospital based system. Over treatment is part of the problem. The U.S. ranks around 37th in life expectancy and we are tied with Slovakia in 29th place for infant mortality. Not great numbers for "the finest healthcare" in the world. Evidence based practice is an absolute must as we go forward to improve our system and cut our OUT-OF-CONTROL spending. I have been a nurse since 1983 and a midwife since 1992 and I love what I do but our industry has REAL problems. I implore you to re-evaluate everything you "think" about health care and educate, educate, educate! We need our consumers to hold us accountable and help us to improve not just an "imperfect" system but a dangerous one.
smartwoman
Well said Carly!!
To vulgrin, my own breast cancer, diagnosed when I was 51, would not have been discovered in its highly treatable early stages had it not been for the comparison to my baseline mammogram taken when I was 40. There are many many others out there who share my history and who have been saved by early detection through mammograms taken in their 40's.
These new recommendations as Fiorina said defy common sense....and now we have the new pap smear recommendations coming out saying that pap smears are unnecessary until age 30. A lifetime of being preached to that early detection was the key can't be wished away by two studies and a political climate that's asking us women to cut corners before anyone else....
bhavanibbana
Actually the "new pap smear recommendations" say that the exam should start at age 21, and be done bi-annually, and then tri-annually starting at 30.
cbeenthere
smartwoman-
I am surprised they did not mention a baseline mammogram, that is probably a good idea at some point. Good point.
crymeariver
The guideline of age 50 and every two years after that is what ALMOST all other first world countries use as a guideline. And women in those countries live just as long as we do but are healthier. It was the recommendation starting in 1997, but people in medicine who benefit from the excessive tests and biopsies went to war politically (radiologists mainly) and the taskforce dropped the recommendation.
Even if you had waited another year or two, your OUTCOME would still be the SAME. That is what they are trying to say. Meaning that women who are diagnoses EARLIER do not live any longer than women who are diagnosed later. Doctors just THINK they do. A lot of things in medicine are not done based on facts and EVIDENCE. Although technology keeps advancing, the field of medical PRACTICE hasn't changed much in centuries. The medical field is trying to move towards EVIDENCE-BASED medicine. Meaning treating people only when there is PROOF that said treatment works, instead of due to TRADITION.
MaliciousDisorder
Carly is Nancy Pelosi's death panel.
Thank you Carly.
cbeenthere
Ms. Fiorina is one story, there are many more, and obviously there is more to the whole story.
escomments
What is this Government Task Force?
Is this the one created from the Stimulus Bill?
Great! They are making suggestions that would reduce the frequency of life saving tests to what end?
Health Care Rationing?
What happens when Health Reform is enacted and this task force has the force of law behind them?
Could it be that they won't be suggestions anymore but decree?
Could this be the Death Panel that those idiot right wingnuts were talking about?
bhavanibbana
Hey, way to disguise your baseless assertions as questions. Do you watch a lot of Glenn Beck? He employs that same tactic.
cbeenthere
Good call out bhavanibbana. Thanks.
escomments
The two of you are idiots!
Why don't you answer the questions?
Because you're left wing koolaid drinkers?
How are those for questions?
dropthedh
CNN actually had the background for this task force. The panel is made of doctors in both the hospital and academic world. It has been around since 1984, created when Reagan was president. The recommendations are just that and insurance companies have been using them for years. So you have already been subjected to their advice.
opedanderson
In light of these recommendations, and despite the denials from the Obama administration that they had nothing to do with them. Does anyone really believe that recommendations like this will not impact Obama-care once it is implemented?
Do you think that the bureaucrats overlooking the expenditures would ever go against such recommendations?
I think not.
Welcome to the future, people.....
bhavanibbana
I hate to tell you, open, but recommendations like this already afffect private insurance. Insurance companies love to put the squeeze on patients when it comes to preventitive screenings, because they're costly and usually repeated. So, all of this sabre rattling about government bureaucrats seems a bit disingenous, or grossly uninformed.
Veronicaxy
Carly, thank you for being willing to talk about this.
Aslanleon
A government task force has determined that mammograms aren't necessary until the age of 50 and everyone here is very upset, and rightly so. If you don't like this decision, you will probably not like a lot of the other decisions government task forces will make on your health care. Since this type of task force will make ALL decisions on what types of treatments and tests are desirable irregardless of your decision or your doctor's, you should prepare to be disappointed if you think you will choose when and where to get tests and treatment. This is just a small example of what the entire system will be like when the expert government panel defines what is good for three hundred million people instead of what is good for you, the patient in consultation with your doctor.
If you die because you couldn't get a test or treatment recommended by your doctor but refused by the government, please don't call the government task force that set the standard a death panel. That would be so . . . conservative.
middleoftheroad
Please ascertain the facts, which are this:
The task force issued a grade C recommendation "against routine screening mammography in women aged 40 to 49 years" and stated that "[t]he decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take into account patient context, including the patient's values regarding specific benefits and harms." As a grade C recommendation, clinicians are counseled to "[o]ffer or provide this service only if other considerations support the offering or providing the service in an individual patient."
Task force encouraged policymakers to include additional considerations and "individualize decision making to the specific patient or situation." In publishing its updated recommendations in The Annals of Internal Medicine, the task force acknowledged that other considerations should be included in determining what preventive treatment to provide, stating, "The USPSTF recognizes that clinical or policy decisions involve more considerations than this body of evidence alone. Clinicians and policymakers should understand the evidence but individualize decision making to the specific patient or situation."
http://www.ahrq.gov/clinic/uspstf09/breastcancer/brcanrs.htm#rationale
sharonsj
It's nice that Carly Fiorina had enough money to pay for her treatments. Imagine what poorer people have to deal with when they can't come up with the cash to pay for the operation. But then again, Republicans and Libertarians usually blame the victim for getting sick. It's all your fault if you get cancer. At least the Dems are trying to address the problem while the Repubs just say no.
Aslanleon
So you think the poor just die when they don't have insurance for an operation? No, they get it anyway. Try to read the notices on the wall of every hospital and emergency room the next time you're sick.
mdreader
So Carly is running for Senator so that she can get health care despite her pre-existing condition?
I do not believe the recommendations apply to those women who have family history of breast cancer. But any recommendations, even those for mammographies, rely on the law of averages. Why don't we have routine mammographies at age 20 or 30? The deadliest cancers hit women in that age group.
What about men? Why not screen men? They get breast cancer too.
We don't because IT IS RARE in those two groups.
We have decades of statistics that PROVE that routine mammographies haven't had any affect on the breast cancer rate for women in their 40's.
What I don't understand is why Carly would fight for a diagnostic tool that didn't work for her in the first place. Is she going to use that same logic for all her other policies?
FranAtlanta
Two things.
As I understand it, the new legislation requires that women and men pay equal amounts for insurance. Reducing mammograms, breast exams (that might trigger medical followup), and pap smears is a way to bring medical costs into line before the bill is passed.
Years ago, my husband was in the hospital and given a 50-50 chance to live out the week. His insurance wanted to send him home - right then. All at once I realized that the least expensive solution for them was for him to die - he had genetic problem that has required a lot of expense over the last 20 years, but his doc fought sending him home and he lived.
So if they can reduce our medical expenses to that of men and if a few more of us die, it will help both medical costs and Social Security.
dixie-chik
Don't confuse insurance companies and government health guidelines. Reforming the insurance industry so that your doctor doesn't have to fight for your husband's life is supposedly one of the benefits of upcoming legislation. Changing the diagnostic guidelines is simply incorporating new learnings and knowings. Annual mammograms are not necessary for most women.
guerrilladude
And we should trust this ex-corporate ceo who was FORCED to resign by the HP board under a cloud of failure (HP's share price nearly dropped by half, and she walked away from that stellar performance with a $20 million severance) why?! I'm glad she caught her breast cancer and appears to have overcome it, but that hardly makes her an expert or a credible candidate for Senate or some kind of role model.
mopper
The recommendations go against my preconceived notions therefore they're wrong. And don't give me any of that "evidence-based" nonsense either. Clearly the the government likes killing people.
Sarcasm aside, this is exactly why we need evidence-based analysis of medicine. We need to find out what works best and institute that as the default system allowing for intervention in instances where it's deemed necessary by individual circumstances.
Besides the trolls who will spew anit-government rants whenever they can and the people who are personally affected by breast cancer and therefore probably not the most objective observers, how can you got against arguments based on the same principals that led to the study of medicine in the first place?
eroteme
Scientific facts found by detailed research over yrs, and "common sense' are not the same thing. I am sorry to disappoint Carly and tell her that there are MANY examples of this in medicine. Rich business people who run or ran mega companies are most often (with exceptions) just like medieval aristocrats and tend to think they know everything and are qualified to comment on everything, and in my experience have long forgotten to listen to evidence and it is dangerous to contradict them. They all then want to run the country as well and are quite delusional about their political skills, although usually they have the arrogance and lying part of a successful political career down pat.
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