It is axiomatic that prevention of disease is better than a cure. No-one (in their right mind) would contemplate for a moment that public health programmes might not work. It is an article of faith that they do. No doubt that philosophy is behind the recently announced Breastcheck launched by the Minister Brian Cowen recently.
Any attempt to reduce cancer among women is, again axiomatically, also laudable and nobody (again, in their right mind) would question the wisdom of a programme intended to reduce breast cancer deaths by one fifth among women aged between 50 and 64. Breast cancer kills about 250 such women annually. Will the screening save 50 lives a year by the end of the first decade of the scheme, as its organisers hope?
Probably not. Sweden recently completed a decade long mammography programme. A study of the 600,000 women participating suggests the decline in the disease was so small that it might have been caused by chance alone. What's more, nearly 100,000 women were given a terrifying, initially incorrect diagnosis. Some 16,000 underwent needless biopsies, and 400 unlucky women had unjustified mastectomies.
Finite resources
Spending money on women's health is politically irreproachable; but does it invariably make sense? Screening so many women every two years cost a fortune, but a further fortune was spent pursuing possible cases and performing thousands of unnecessary operations. Yet surely saving life is worth any and every effort? Individually, yes; but as a broad philosophy, no, not in this world with finite resources and so many diseases, with so much longevity and a medical hyper-industry whose own growth is as uncontrollable as a tumour.
Moreover, breast cancer is not the only gender-specific lethal illness. Politically unnoticed, prostate cancer kills over 500 men a year in this State, seven times as many fatalities as are caused by cervical cancer, for which there is a huge, State-funded detection campaign. There's no programme at all to detect and cure cancer of the prostate gland. Such is the scale of State denial about the realities of prostate cancer that the digest from the Central Statistics Office lists deaths from the various female-specific cancer forms, but male cancer forms are concealed under the general category "other malignant neo-plasms".
More men die from cancer than women, but you'd never know it from the public health campaigns launched by the Department of Health, or from its budgetary priorities. Indeed, it is not so much a matter of well informed health policy as an unassailable political doctrine that far more should be spent on women's health than on men's. If any attempt were made to shift the budgetry balance in favour of the neglected, sicker male of the species, there would be uproar from the feminist lobby. The underlying message is in fact a cultural norm throughout our society; men's lives don't count as much as women's.
Use of language
We see this in the most casual use of language. Fifteen passengers killed in a bus crash, three of them women: that is the way we report all disasters. The normative and unremarkable event is male death; the unusual (and more tragic) event is a woman dying. This attitude is so in-built that men and women alike regard the death of a young female stranger as being a vastly sadder business than the death of an equivalent male.
We are culturally profoundly unegalitarian. Suicide is a case in point. As a cause of death, suicides are rocketing, growing at an appalling 40 per cent a year. Suicide is many ways similar to cancer. It is a lifestyle disease with a strong genetic factor. There is usually a long and tortured prelude, causing immense unhappiness both for the victims and the victim's family, concluding in an emotionally devastating and often horrific death.
Long before Breastcare concludes its 10-year span, suicide will be a greater killer than mammary cancer. Last year there were over 500 suicides, 90 per cent of them male. When John Waters wrote about this recently, the only response from the medical establishment was a disdainful rebuke. Nobody within that establishment admitted the obvious: these deaths are largely avoidable, and the failure of the State to tackle the catastrophe of suicide among young men is not so much a matter of health as political will. Their lives, their deaths, are of less importance than those of women.
Current demands
The same day that Breastcare was announced, the Southern Health Board warned that junior doctors in one Cork hospital were working 120 hours a week. This is not merely wicked; it is insane. We have a medical industry which cannot cope with the current demands being made on it without resorting to medical galley-slaves. How will it manage once Breastcare, say, calls on it to scan 100,000 women every two years and, if the Swedish experience is anything to go by, to perform some 3,000 unnecessary biopsies and remove some 80 or so perfectly healthy breasts?
The organisers of this campaign say that it has in-built safeguards "to avoid the difficulties" of elsewhere. "Difficulties" is an interesting word to describe thousands of purposeless operations at vast expense yet with no decisive reduction in death toll. And there is the broader question: if middle-aged women are all to be screened for breast cancer, why should we all not be screened for all illnesses? Or come to that, why should we all not have a private swimming-pool, six months' annual holiday and a private jet?