To the Editor:
Re “Earlier Screening, Yes. Overtreatment, No,” by Mehra Golshan (Opinion guest essay, May 18):
When I was 44, my routine annual screening mammogram detected a distortion that turned out to be a highly aggressive and dangerous form of breast cancer. Fortunately, because I was screened annually, it was caught at an early stage and was treated with a combination of surgery, chemotherapy and radiation.
That was 22 years ago. Now that I’m well into my 60s, I’m grateful every day for the mammogram that caught that deadly cancer early enough to save my life. It has given me so many rich and wonderful years that I surely would never have had if screening mammograms weren’t available till age 50.
Statistically, annual mammogram screening for breast cancer before age 50 may not “save enough lives,” but it surely saved mine.
Deborah Schueneman
Farmington Hills, Mich.
To the Editor:
Like Dr. Mehra Golshan, I am a breast cancer surgeon, and I wholeheartedly agree with his view of the new screening guidelines. Screening women in their 40s saves lives and also substantially reduces the need for toxic, burdensome and costly care.
Modern imaging detects small cancers with fewer “false positives.” Many patients can keep their breasts, and those who need or choose mastectomy can have reconstruction. “De-escalation” of systemic therapy achieves better outcomes with less treatment. And radiation oncologists now offer less burdensome treatments with improved outcomes.
So we need to ask ourselves: Why do so many women present with advanced cancers, and why do some choose mastectomy when they can be equally well treated with a lumpectomy? Certainly there are racial and socioeconomic disparities, and these need to be addressed. But the overwhelming reason is fear.
Let us strive to reduce the fear and the stigma of a breast cancer diagnosis, and use the tools we have to reduce unnecessary procedures and treatment. The new guidelines will go a long way toward accomplishing this goal.
Robert Buras
Annapolis, Md.
To the Editor:
As Mehra Golshan points out, we have a way to go before we can make more individualized screening recommendations. But the Tomosynthesis Mammographic Imaging Screening Trial addresses some of his concerns.
The trial is currently enrolling more than 100,000 women to give us information about how to move beyond our current “one size fits all” approach in which we screen most women the same way based on age-specific guidelines. The trial randomizes women to digital mammography (2-D mammography) or breast tomosynthesis (3-D mammography). Images and data from every mammogram are collected, along with blood and tissue samples that researchers will be able to study in the future.
Nearly 130 sites are currently enrolling across the country from large urban academic medical centers to smaller community hospitals like mine. As a result, participants represent the great diversity of women in our country.
The trial will help us move toward a more personalized approach that tailors mammography for each woman based on her own genetics and individual risk factors for developing breast cancer.
Amarinthia Curtis
Etta Pisano
Dr. Curtis is a radiation oncologist and a community co-chair of the Tomosynthesis Mammographic Imaging Screening Trial. Dr. Pisano is a radiologist and the study chair of the trial.
Outdoor Dining in New York City (Some of the Time)
To the Editor:
Re “Outdoor Dining Is Here to Stay in New York City’’ (news article, May 19):
The New York City Council’s bill on outdoor dining is a scandal. The bill allows restaurants to erect outdoor dining structures, but only from April through November — a rule that will discourage their use overall.
New Yorkers deserve more from our public space, and our public officials. In the most dense, transit-friendly city in the nation, our leaders have decided to kill year-round outdoor dining sheds in order to protect outdoor parking. These lovely, lively gathering places will once again become free parking spots for many of the city’s wealthiest residents.
Even worse, the bill also disincentivizes restaurants from investing in well-made outdoor structures. After all, they’ll have to tear them down each winter and rebuild. Think the sheds look shabby now? Just wait.
Nicholas Teddy
Brooklyn
To the Editor:
It’s good to read that the City Council is considering a bill to license outdoor dining structures. We New Yorkers who enjoy outdoor dining also want to restrict the rats, maintain sufficient sidewalk areas for pedestrians, allow for roadway access to vehicles and keep our neighborhoods at tolerable noise levels with these outdoor sheds — all of which we hope the bill will address.
The one issue that never seems to be talked about is the wastefulness of the air-conditioning that comes spilling out through open doors and windows as waiters and customers move in and out of dining areas.
Restaurants are already overly air-conditioned in the summer months, often requiring patrons to wear sweaters to dine comfortably. But the air-conditioning is basically cooling the sidewalks in many of these indoor/outdoor situations. How will the City Council address this dilemma?
Pauletta Brooks
New York
Employee ‘Belonging’
To the Editor:
Re “The D.E.I. Movement Picks Up a Word: Belonging” (Sunday Business, May 14):
Many of the organizations featured in the article misunderstand the importance of both “inclusion” and “belonging” as goals to achieve an equitable workplace.
Belonging and inclusion are not interchangeable. Inclusion is the how. It is the hard work of transforming systems, practices and policies to acknowledge and integrate the norms, values and experiences of the diversity of employees.
When inclusion is done right, employees, especially those who identify with traditionally marginalized identity groups, feel appreciated, accepted and treated fairly. They feel they belong.
Employee belonging is the outcome of an inclusive workplace. A more helpful article would have dug deeper into the workplace changes needed so that all employees, especially those who identify with traditionally marginalized identity groups, can bring their “whole self to work.”
Regis Anne Shields
Cambridge, Mass.
The writer is principal and co-founder of Equity Journey Partners, which works with school districts on D.E.I./Belonging issues.
Making Urban Rivers Swimmable
To the Editor:
Re “Taking a Dip in the Seine Deserves a Medal” (Sports, May 12), about Paris’s efforts to make the Seine clean enough to swim in:
If Paris can do it, why not Boston? Or every urban river in America? In 1972, the Clean Water Act set a goal of fishable, swimmable rivers by 1983, yet here we are 40 years later with too many of our urban waterways still being polluted from storm water runoff, sewage overflows and more.
We have made great progress since 1972 — we no longer have rivers routinely catching on fire — but the job is not done until our urban residents can cool off on a hot summer day by jumping or wading into the refreshing waters of a clean river.
Ian Cooke
Patrick Herron
Emily Norton
The writers are the executive directors of three watershed associations for rivers that feed into Boston Harbor.
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