18 thoughts on “Things that cannot screen for breast cancer

  1. The linked site wades into the controversy over last year’s revelation that Planned Parenthood doesn’t do mammograms (see, e.g., http://www.washingtontimes.com/news/2011/mar/30/tapes-planned-parenthood-mammogram-claims-false/). The site notes that “‘Screenings’ are also breast exams, which are the first line of defense. Those breast exams are done every time a woman has a pelvic exam, which she needs in order to get birth control or STI testing.” Assuming the second sentence is true, that’s a valid point. But I would like to hear Cecile Richards, the corporation’s CEO, explain this one. She absolutely did suggest on television that that if Planned Parenthood lost its federal funding, it would adversely impact the company’s ability to continue to provide mammograms.

  2. Nemo, I think that’s questionable reporting, if it says that no PP clinics provide mammograms. Some do and some don’t. no surprise there. Here’s a map of the places in Texas that provide free or reduced cost mammograms: http://batchgeo.com/map/bccstexascliniclocator
    Below it is a list of the clinics (or the clinics in some areas) that provide them. There are nine PP clinics in the list, as my fallible counting had it.

    One clinic in Waco says explicitly that they do so because of funding from Komen.

    I don’t know in general about reduced cost clinics, but I know a bit about the ones in Houston. There is a serious difference in waiting time between the reduced cost clinics and regular clinics. If you have a lump in your breast, waiting for a month or two before a clinic can do a diagnostic mammogram would be, I should suppose, pretty awful. From a more biological point of view, if your cancer is slow-growing, 2 months is not too bad. If it is fast-growing, you can be at a later and more dangerous stage. The diagnostic mammogram is a typical first step toward serious diagnosis; it is more costly and complicated, but what you need if there’s a chance of cancer. If you have insurance, the wait at Texas Women’s Hospital is a few days.

    I think one horrible thing going on is that the issue of what happens to poor women is too often just left out.

    That all said, all sorts ofl factors – money, culture, education – apparently are thought to play a role in the fact that some women are less likely to get mammograms. In that case, a place where breast exams are part of a more general reproductive health clinic is extremely important.

  3. Anne, it’s possible that some Planned Parenthood clinics provide mammograms (at least or have started doing so since the time of the controversy). I can’t confirm this from the link you gave though, and the fact that the corporation’s response to the no-mammogram controversy was to dispute that it had ever claimed that any of its clinics performed mammograms does not exactly inspire confidence. (I’m not talking about referrals out to non-PP clinics for mammograms for which PP might be inclined to take credit, which is a different matter.)

    At the very least, if someone can cold-call 30 PP clinics in 27 states including Texas, and none of them provide mammograms or can identify another PP facility that provides them, and a fair number of the called clinics state that PP as an organization does not provide mammograms, one may reasonably suspect that at *most* a miniscule percentage of PP clinics nationwide conduct mammograms (which would still make their CEO’s statement misleading – she actually put mammograms at the top of the list). Sure, it’s not a huge sample size, but come on:

    At any rate, I would hope and expect that Komen will redirect this money in an equally if not more effective direction. I think Ambassador Nancy Brinker, Komen’s founder, explains the decision well (“Wherever possible, we want to grant to the provider that is actually providing the lifesaving mammogram”):

  4. This may be a question of semantics. Does the mammogram take place on the clinic grounds or do they provide you with access to mammograms at another place? Mammograms are very high tech matter. They require quite a bit of training, experience, insulation and so on. Overhead and maintenance costs can be very high. If a PP clinic can spare the expense of putting the equipment in place, they may want to.

    here’s a link to a PP clinic that says it has a grant from the koman foundation that allows it to do something like help women get mammograms.

    I would never take the evidence of someone answering the telephone at a clinic as definitive, sadly enough. I spent three days dealing with a family health emergency this summer, and getting someone who knew what the facility did could drive one insane. I spent an hour getting switched on the phone back and forth among departments until someone hung up on me. Certainly, such a person might well know that mammograms are not done on the site without knowing to say that the doctor can refer a woman for a free mammogram because of PP funds.

  5. I watched the video Nemo provides above with the title, “Planned Parenthoood cheates taxpayers with imaginary mammograms,” and I find the title of the video insulting to human intelligence insofar as it is grossly mischaracterizing of the content. The lady is saying that if some bill becomes law — it is unclear what bill, and I suspect the beginning of her speech is cut off because then the context would be clearly not about PP services — then women will lose access to health services including mammograms. How this is proof of PP either “cheating taxpayers”, imagining services, or failing to provide health care that includes breast exams, utterly escapes me. I find it outrageous that this was trumped up into a ‘controversy’ by a group that devoted itself to ‘disproving’ something which was never claimed.

    Further, I went for annual exams to Planned Parenthood when I was poor. I went there for the excellent reason that I was poor. I didn’t get annual breast exams and pelvic exams “in order to get birth control or sti testing”. I went because I could get breast exams (given the age my mother got breast cancer, I’m a candidate for the hereditary strain) and I was in a sexually active marriage in which we weren’t trying to prevent pregnancy but DID want to know if by any chance I had cervical cancer! I am grateful that Planned Parenthood screened me for breast cancer regularly, I am relieved that they caught some mild displaysia when they did, and I am glad they continue to provide such services, although I am now comparatively wealthy and no longer ask for their services.

  6. I think Brinker is being disingenuous, along with making nasty little suggestions about standards, when the “investigation” into planned parenthood was about financing abortions.

    Why in the world would one think it is a good strategy to fund just people with mammogramfacilities on site? Women are not diagnosticians. Many breasts have all sorts of lumps, and there are many reasons any breast can get a lump. In between a woman and a mammogram, there is very often a doctor. Even with regular mammogram users, the results are sent to a doctor who should be keeping a check on changes.

    PP is like the front door to mammograms for many women. Or was.

  7. I should add, for clarification, that this is not a question of semantics. That is overly charitable and indicates that the statement in the video is ambiguous as to whether or not the PP officer is saying PP provides mammograms. But it is not ambiguous. She does not say PP provides mammograms. She is speaking about some sort of bill, and the effects of its passage or not on women who are not wealthy. She does not say anything about PP in the video. She simply does not.

  8. Profbigk, the bill she’s talking about was the the bill specifically to pull PP’s federal funding. She’s talking about how it will affect PP, not some other putative provider of mammograms.

  9. profbigk, I think you are right, but I’m not sure. She seems to be saying that if PP is not funded, then women lose access to mammograms. That may not be ambiguous, but it might be misleading, even if she didn’t intend that people to think providing access is pretty much providing tout court. For example, one might say that if there is no public funding for buses or the underground, lots of students in NYC will lose access to university education. But I think there is a conversational implicature in the PP case that the access is more closely linked than transportation and education. And I have no doubt it very, very often is. PP may provide different kinds of access to mammograms, and additionally, mammograms are very often only part of the procedure in which they play a diagnostic role.

    When I was provisionally diagnosed with breast cancer, the clinic had NOTHING to do with what led me there and they provided NOTHING in the way of access to any treatment or even access to what was the needed next confirming step. I thought I had a cyst, and another symptom led my doctor to say to have a mammorgram; even then, the mammogram and their ultra-sound couldn’t rule that it was a cyst. Thus the mammogram was a very small part of what took me from checking up on that possible cyst to the final diagnosis. Most of the management of what took me to the final diagnosis was done by someone playing the role that PP does.

    It may look as though the role played by a mammogram is just like the role played by a photo. Everything is regularly photoed; people look at them, see what is there, and then take appropriate action. That is far from what happens. One of the first things that happens is that one is given a HUGE folder which you use to help keep track of all the different agencies, etc, you will be seeing as people try to figure out what is really going on, and where exactly the problem is. I.e., has it spread? It’s pretty clear to me that any withdrawal of links in that complex chain from first sign to the operation-and-further-treatment is going to cost lives. Surely, the links before the mammogram are very important.

  10. There has never been a bill to pull PP funding. Oh, do you mean the House Appropriations Bill and Rep. Pence’s failed amendment? The Pence Amendment proposed the funding be 100% eliminated for Planned Parenthood as well as 102 affiliated organizations. However, if you are talking about the House Continuing Resolution, now THAT was a bill, and it proposed defunding of all Title X services, which of course includes mammograms.

    Pence pulled the text of the amendment from Thomas and GovTrack after it failed, so I don’t know what all the 102 affiliated organizations are. Note that organizations are not identical to mere clinics.

    I repeat my original point, since the attention to the mammogram thing is an evident attempt on the part of Live Action to distract attention to a minor thing (who gives a care whether my lump is caught by the breast exam of the excellent ob/gyn at PP or a damn machine?). The major thing is this: I got free breast exams as a poor and high-risk woman from PP. I am eternally grateful to them for the provision of this most effective form of cancer screening.

  11. anonfemphil, the video includes the clip of her saying women won’t have access to basic sorts of health care, and then she says ‘mammograms.’ If she’s talking about the Pence amendment, which Pence has since made unavailable, then I agree, she is likely talking about PP and not one of the 102 affiliated organizations. But even then, there’s the very true general point: without PP, women who depend upon it would therefore lack access to basic services. And then there’s this specific point about mammograms, one type of breast cancer screening, which at worst was an inaccurate reference to the particular services PP provides. Making this into a controversy that had to be ‘exposed’ is clever politics but, again, a distraction from her main point.

    But I should add: Thanks, anonfemphil, for your personal account, which is richly informative.

  12. Anne, I should add that I don’t endorse the caption of the video, which was already on the only linked copies I found of the mammogram tapes in the press. However, I can’t concur that it grossly mischaracterizes the content. In that interview, the CEO was lobbying for public support of continued federal funding of her company, and the fact that she indicated that removing PP’s funding would cause millions of people to lose access to mammograms in that context is likely to lead taxpayers to think that her company and its affiliates are actually engaged in conducting mammograms.

    Can it be interpreted differently? Sure, with a little extra rationalization. But if an analogous statement appeared in, say, a prospectus intended for some company’s investors, I think there would be a colorable cause of action for securities fraud if anyone relied on the statement’s implications in part to justify their decision to fund the company – and there would be claims that the company cheated its investors, just as the video caption suggested that Planned Parenthood cheated (or attempted to cheat) the taxpayers. I can see possibly calling that caption a mischaracterization. But not a grossly unfounded one.

  13. I don’t need extra rationalization to interpret her words. I need only the text of the Pence Amendment, which included 102 affiliate organizations in addition to PP and which are no longer a matter of the public record. It is not extra rationalization to point out that her main argument was women would *lose access to basic sorts of health care*, and that to say ‘mammograms’ may be inaccurate but is hardly her main point. Attending to the difference between her main point, and her inaccurate example, is not extra rationalization. It is attentive, it is logical, and it is charitable of me.

    That caption/title/whatever is grossly unfounded because it says, “Planned Parenthoood cheates taxpayers with imaginary mammograms.” Did PP set out to cheat taxpayers with imaginary mammograms? ON what dimension are taxpayers actually being cheated by the provision to women in poverty with, in the words from the video clip, basic health care?? Cheating taxpayers is an emotional ploy, a provocative claim which attributes intentional nefariousness to PP. That is grossly unfounded.

  14. Anne, I’m guessing that you don’t view House Concurrent Resolution 36 as a bill, which in the most technical parliamentary terms it was not. However, it’s available here:

    Click to access BILLS-112hconres36rds.pdf

    It just talks about PPFA Inc. and its affiliates. I think we do have a pretty good idea of who the affiliates are just by looking at the list of them on the Planned Parenthood website:


    It’s essentially the state and local affiliates, e.g. “Planned Parenthood of [Anytown]”.

  15. Oh, I’m not Anne, I’m Kate, a.k.a profbigk.

    This bill is from April, and the video clip is from February — wait, you’re not saying this is the one the video clip is about. Okay, this isn’t 102, but it’s something, and is a list of the regional office branches. They can provide any number of referrals to any number of health care offices; these are not the addresses and numbers of the clinics “exposed” by Live Action as having no mammo-machines, and the reason that I am certain of this latter point is that none of the clinics I went to are on this list. I have called the main office in Milwaukee that is listed, and indeed they helpfully referred me to doctors outside of PP for my particular needs when I was potentially cancerous.

    Of course, all this is very much beside the point, which is that PP provides annual breast exams to those of us who may be high-risk and have insufficient money, that PP’s funding, if eliminated, indeed would affect the access to basic health care of the women mentioned in the clip, and that of course an ob/gyn checking for breast cancer counts as a screening, which it is bizarre to me to even debate. As Anne said it best in the second comment: “I think one horrible thing going on is that the issue of what happens to poor women is too often just left out.”

  16. Profbigk, I know you’re not Anne, it was a regrettable mental slip whereby my subconscious confused you with another “grande dame” of FP (no connotation of age intended). I apologize. Anyhow, you make excellent points and I will reflect and hopefully revert when I have a little more time later.

  17. Twice around the park, driver!

    Anyhow, where were we? Oh yes: I think it is not disputed, and so need not be argued, that Planned Parenthood and/or its affiliates provide some forms of breast screening, and in any number of cases this screening has led to some very good outcomes for which we can all be thankful. (Doubtless the same could be said of some organizations, too, that receive funding neither from the government nor from Komen.)

    I suspect, though I can’t know, that the list 102 named PPFA affiliates apparently included in the original legislative proposal was intended to reflect the same group of 79 currently named on PPFA’s website – that is, all the state and local outfits operating under the PP name – allowing for the fact that some of those entities may have been consolidated or dissolved in the intervening time, and that the larger list may not have been entirely accurate in the first place. It does not surprise me at all, profbigk, that the list of addresses of the 79 would not contain (or at least not contain all of) the individual clinic addresses, since the administrative or registered office of the affiliate might not coincide with the clinic locations it maintains.

    Profbigk, when I referred to “extra rationalization”, I was referring to what might be required in order to interpret the CEO’s mammogram reference, specifically, as accurate. Put another way, I think that one could rationally interpret the reference it in a such a way as to render it not inaccurate (which may have been the the intended interpretation), but that such an interpretation is the less natural and more strained interpretation. I agree with you that “it is not extra rationalization to point out that her main argument was women would lose access to basic sorts of health care”, but that is not what I was suggesting would involve “extra rationalization” (i.e. denial that the example was inaccurate). I think we were simply speaking at cross-purposes there.

    I’d like to consider the idea that the sentiment expressed in the Live Action video’s title is grossly unfounded. Profbigk has offered a very persuasive argument to that effect, but I think there is a contrary argument to be made as well, if I may presume to propose it.

    If the taxpayers or their representatives were led to believe that their tax dollars were subsidizing the actual provision of mammograms by Planned Parenthood (as in fact I previously believed, though not solely on the basis of the CEO’s statement from the video), and this was not the case, I submit that it is not unreasonable that some of them might feel as though the tax money was procured under false pretenses – by a form of cheating, for lack of a better word. I completely agree that it is probably not possible to establish that the CEO subjectively understood that the mammogram claim was misleading, but to my mind that doesn’t necessarily make the sentiment of having been cheated completely unfounded. Many fraud claims, for example, are based on constructive intention – that is, that someone *should have known* that they were misleading someone else, even if it was not subjectively their intention to do so. And where solicitations of other people’s money are involved (such as in the stock market, for example) it fairly widely accepted that even minor, arguably beside-the-point inaccuracies assume a disproportionate gravity. In a general way, the CEO intended for the public to rely on her public statements about the funding in order for that funding to be secured, and it is not wholly unfair to place the onus on her to avoid even unintentionally misleading statements. So the view that in some sense a fraud or something like it was being perpetrated does not strike me as completely bizarre or irrational (hence not “grossly unfounded”) even if it is a view I do not happen to share.

    I would note with regard to the foregoing that while objecting that taxpayer money would still go to purposes like providing basic health care may constitute a perfectly serviceable defense of the allocation of taxpayer funding to Planned Parenthood, it is nonetheless no defense at all to the particular criticism levelled in the video.

    On the subject of the imputation of nefarious intentions, I’ve described above why I don’t think such specific intentions are absolutely necessary in order for fraud or something close to it to occur. Naturally, I agree that there is no specific evidence that the corporation (through the person of its CEO, of course; attributing any state of mind to a body corporate is problematic I suppose) had a bad intent with the mammogram claim. Yet in fairness I think it must be observed that Planned Parenthood has lately burned up a lot of its presumption of good faith in the public eye, what with various revelations from stings and whistleblowers that are suggestive of a scofflaw corporate culture. So it is, if not entirely fair, perhaps at least understandable that some people might be excessively reluctant to accord the benefit of the doubt to Planned Parenthood’s motives. There, I fear, the corporation may have made a rod for its own back.

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