Charlotte Crowder lives and writes on the coast of Maine. She is a medical writer and editor by day. Her short stories have been published in Maine Boats, Homes and Harbors magazine, The Maine Review, Boston Literary Magazine, Brilliant Flash Fiction, and American Writers Review. Her essay “In the Pink” appears in the Fall 2019 issue of Intima: A Journal of Narrative Medicine.
In the form of a dictionary entry, Daniel Waters’ Field Notes titled “Meaningfull” (Spring 2015 Intima) includes definitions with both positive and negative connotations for the word “surgeon” and emphasizes what I sought to say in my piece: Medical interventions have the potential for either positive or negative outcomes.
I wrote “In the Pink” in the hopes of raising awareness of the potential negatives of current mammography screening practices. I must first say, that I in no way belittle the ravages of breast cancer, a disease which took three of those most dear to me. Also, as a medical writer, I have been privileged to work on the development of a variety of cancer therapies, including the early trials of immunotherapy, drafting the protocols for clinical studies and later writing up their results. I know that several of those therapies are now approved and grant individuals many years of full life they would otherwise not have had. In The Big Squeeze: The Social and Political History of the Controversial Mammogram (2012, Cornell University Press), the late Dr. Handel Reynolds, former Chief of Breast Radiology at Indiana University, documented that the number of mammography facilities in the United States expanded from fewer than 200 in 1982 to approximately 10,000 in 1992 [p. 46-47]. After 2000, digital mammography machines came into wide use; mammography departments were becoming significant profit centers for hospitals, even at the tiny hospital in the rural community where I live. The machines were promoted as an improved technology for the earlier detection of small breast cancers. According to Dr. Reynolds, many of these small cancers were ductal carcinoma in situ (DCIS), “a disease that was largely unknown prior to the era of mammographic screening” [p 86].
Furthermore, he explained that most DCIS cases do not progress to invasive cancer and in that circumstance they are completely harmless. Writing in 2012, he stated that at the time DCIS accounted “for 20 to 25 percent of all new breast cancer cases.” He maintained that the practical effect of improved DCIS detection has been to create a huge new class with a breast cancer diagnosis [pp 86-89], essentially all of whom undergo treatment, typically lumpectomy and radiation therapy, but also often mastectomy” [p 31]. Patients and practitioners alike should keep in mind his warning that “overdiagnosis and mammography are inextricably linked” [pp 85-86].
Charlotte Crowder lives and writes on the coast of Maine. She is a medical writer and editor by day. Her short stories have been published in Maine Boats, Homes and Harbors magazine, The Maine Review, Boston Literary Magazine, Brilliant Flash Fiction, and American Writers Review. Forthcoming are short stories in Dirigo Dreams Anthology (City View Press, Fall 2019) and Anthology 2, Dreamers Creative Writing (Winter 2020). Her first picture book, A Fine Orange Bucket, was released by North Country Press in June 2019.
2020 Intima: A Journal of Narrative Medicine