Today (May 30, 2018) the American Cancer Society recommended new guidelines for screening for colon cancer, which comes after research showed that adults younger than 50 were experiencing increasing rates of colon and rectal cancer.
I want to compare and contract screening for cancer with screening for postpartum depression. As a survivor of both, I feel uniquely situated to share some thoughts.
First up: colon cancer.
Each year in the United States, about 140,000 people will be diagnosed with colon cancer. The lifetime risk of developing colon cancer is less than 5%, yet screening guidelines are well-recognized and widely implemented, and colonoscopies and other diagnostic tests are easy to schedule and are covered by insurance. Treatment options – based on staging and other criteria — are fairly straightforward and standard and again covered by insurance. Patient navigators are available to assist with making appointments, coordinating care, and keeping the patient moving forward. Doctors – surgeons, oncologists, radiologists – work together to create a plan of care and provide warm hand-offs from one provider to another. Electronic medical records ensure that all tests, doctors’ notes, and treatments are accessible to multiple offices and providers.
Now let’s look at postpartum depression and other perinatal mood and anxiety disorders (PMADs).
Each year in the United States, approximately 800,000 women will experience PMADs. The risk of experiencing PMADs is 20%, making these illnesses the MOST COMMON complication of pregnancy and childbirth, yet maternal-child healthcare providers often do not receive any training about these issues, are not reimbursed for screening, and do not know where to send affected women for help. Screening guidelines can be ambiguous (the American College of Obstetricians and Gynecologists recommends “once during pregnancy”). Perinatal navigators are scarce. While treatment options are well-noted (self-care, social support, talk therapy, medication), they are not well-known by maternal-child healthcare providers. Most therapists and virtually all psychiatrists offer pay-as-you-go treatment and do not accept insurance. Very few obstetric practices have embedded behavioral healthcare, resulting in lots of hand-offs and women falling into cracks created by lack of coordinated care.
So, generally speaking, we don’t talk about perinatal mood and anxiety disorders, we don’t screen for them, and we let women fall into the abyss of anxiety or depression…and then expect that they can advocate for themselves and navigate the complex mental health industry when they are at their most vulnerable.
When I had colon cancer, doctors and nurses were kind and caring; friends and family and strangers offered all kinds of help; and I knew exactly what my course of treatment was.
When I had postpartum depression, I was all alone and I thought I was never going to get better.