Outrage, confusion, and celebration. Yes, I have heard all three of these sentiments echoed as the new mammogram guidelines hit the air this week. The American Cancer Society is changing mammogram guidelines based on personal risks. For those that think this is shocking or revolutionary, I welcome you to the tentative steps by a medical giant into the world of personalized medicine.
As a nation, many studies have explored our over-treatment and over-diagnosis of breast cancer. But breast cancer is a real and palpable issue for American women, with almost one out of eight women having a breast cancer diagnosis at some point in their lives. Are these new recommendations reckless? Or are they simply an attempt to lower the over-treatment? (1, 2)
I am excited about the new recommendations simply because they indirectly acknowledge a simple fact. We are all unique -- not one of us mirrors the chemistry, the biology, the genetics or the lifestyle of our sisters. One person's feast is another's poison, and the same holds true for breast cancer. With the majority of cases being sporadic, rather than familial, there is an underworld of chemistry and hormone changes that is the breeding ground for cancer. I am excited that we have to think through each patient, understand their background and their individual risks and actually have a conversation, longer than 1-2 minutes, that explains why or why not they may need a mammogram. (3)
Yet my excitement is tempered by the sobering fact that as physicians, we may not yet be equipped for those individual conversations. I am not sure that the current medical model gifts the physician with time to have an intimate conversation or to delve into a patient's chemistry or background. Does the current medical model even value the physician-patient relationship, or have the woes of reimbursement moved today's physician to a corporate employee, limited in the ability to be expansive, creative and thorough with their patients and beholden to the insurance company? Does today's physician even have time to foster a relationship with their patients?
You see, if personalized medicine is the future of medicine, and every patient will be seen in the guise of their unique chemistry, then the medical model will have to change. We will have to return to the intimacy of that relationship, the conversations, the relationships; the heart of medicine. We will have to empower both physicians and patients with a voice, a voice that unites into a clear, directed plan, patient after patient, exam room to exam room. We need to think about patients as partners, customers and shareholders not as visitors or even as patients, as we strive to create a medical model that gives them a voice and gives the physician a place at the table. Assembly line medicine, just like assembly line food is not working. Let's change the medical model so that personalized medicine really is the medicine of the future.