Mammogram Recommendations Could Reverse Years of Progress

November 19, 2009 RSS Feed Print
  • Comment (19)

By Mary Kate Cary, Thomas Jefferson Street blog

I'm upset about the controversial decision by the U.S. Preventive Services Task Force—an agency appointed by HHS, the federal department at the center of healthcare reform—to recommend that women not begin regular mammograms until age 50, and even then, only every two years.

The breast cancer awareness lobby in the United States has spent years convincing women that we must get checked early and often for breast cancer. It's just what you do: Every year I get my teeth cleaned (twice), I get a Pap smear and a mammogram, and get my cholesterol checked. It's part of being a grownup. It's as if they came out and said that seat belts in cars really aren't necessary anymore, or that it's okay for pregnant women to drink tequila again.

According to the New York Times: "The task force concluded that one cancer death is prevented for every 1,904 women age 40 to 49 who are screened for 10 years, compared with one death for every 1,339 women age 50 to 59, and one death for every 377 women age 60 to 69."

No one wants to be the one woman—the one mom, sister, daughter, or friend—whose death was preventable. Who wants to take that chance? Two years is a long time to wait and wonder. I bet most women will pay for a yearly mammogram out of pocket just for the peace of mind. Many paid out of pocket a few years back when the new improved Pap smears came out and insurance wouldn't cover the difference. I know I did.

The task force also recommended that doctors stop teaching patients how to do a self-exam for breast cancer on a regular basis. What? We all know women who have survived breast cancer in their 40s who either found a lump by self-exam or had a bad mammogram. So if you're cutting back on mammograms and telling women to stop the self-exams, what other way is there to find breast cancer?

According to the American Cancer Society, "death rates from breast cancer have been declining since about 1990, with larger decreases in women younger than 50." The improvement in survival rates reflects progress in early detection, increased awareness and, to be fair, better treatments as well. The last thing we should do is reverse that progress by cutting back on early detection.

If this is the beginning of reducing costs as part of healthcare reform—as some pleased observers have called it—why did we start by rationing healthcare for women, especially such a high-profile disease that affects so many of us?

Tags:
women's health,
breast cancer

Reader Comments Read all comments (19)

Add Your Thoughts
Your comment will be posted immediately, unless it is spam or contains profanity. For more information, please see our Comments FAQ.

I question the conclusions of groups like USPSTF. There is a whole series of events intervening between screening, biopsy, detection of possible cancer, sometimes early stage, decision making in collaboration with physicians, possible treatment, outcome. Missteps in any one of the stages can lead to an undesirable outcome EVEN IF screening provides a key starting point (which all of the experts believe --- no matter what the statisticians conclude). So why are the statisticians wrong? Because they ignore the path. For example, a report has just come out , showing that the majority of prostatetectomies in this country are performed by surgeons with extremely limited experience resulting in a substantial reduction in effectiveness and increase in negative side effects. But wait you say, what does that have to do with PSA screening. Simple --- many of the men getting inferior treatment had their initial diagnosis via psa screening. So a study by USPSTF which just looked at PSA and at final outcome would "conclude" that the PSA screening didn't work, when what really didn't work was a further step the surgery because of the incompetence of the surgeons. USPSTF needs to look at these sorts of factors before coming up with much in the way of useful conclusions in my scientific opinion, or else all they should conclude is that you don't have good followup available don't get mammograms and PSA tests. More importantly --- we need advice on how to get qualified practitioners, not on avoiding obtaining potentially useful knowledge about whether or not we have early stage cancer. From the report:

www.medscape.com/viewarticle/713012?sssdmh=dm1.560691&src=nldne&uac=121910CN
November 25, 2009 — The majority of surgeons performing radical prostatectomy in the United States have extremely low annual caseloads, which can result in an increased risk for surgical complications and cancer recurrence, according to a new analysis published in the December issue of the Journal of Urology.

Lee Smith of NY 7:37PM November 28, 2009

While the US Preventive Services Task Force recommendations for breast cancer screening for the 40-49 y.o. age group of women did NOT change since 2002, the uproar in the press continues. This brings to light the conflicting recommendations as to what constitutes the standard of care in medicine today. The issue is that there are different standards for the same disease across specialties and across the first world. Ironically, the USPSTF is recognized as “the standard” worldwide for making prevention guidelines because of the extensive review of medical research that goes into the process to determine public health guidelines for the general population. The American Cancer Society and other groups are looking at the sub-segment of the population diagnosed with cancer, not the proportion of those people relative to the entire population. Interestingly, no one has mentioned that these groups may have their own political, legal or monetary concerns. If it costs more to screen people to find one case of disease than it does to treat one case of disease (at the average stage it would be found), there is no point in screening. It costs more than it’s worth. [Obviously the individual who may have cancer doesn’t feel that way. But from a societal standpoint, where money is not an unlimited commodity, we must seek the biggest bang for our healthcare buck.] In this case, a better screening test that does not yield a cumulative 43% false-positive rate by the ninth mammogram or a cheaper one to make it worthwhile for this age group.

More info at aocopm.blogspot.com

Dr. Debra A. Smith of IN 5:20PM November 23, 2009

Let everyone be forewarned, this is what we have to look forward to with Obama care, Pelosi care and Reid care. This isn't reform, it's the outright destruction of our health care system.

Anyone who can't see the writing on the wall is either blind or ignorant.

Our country is being destroyed by the likes of this government panel who was appointed by the politicians we have put in office.

Left Coast Geno of CA 3:58PM November 20, 2009

Mary Kate Cary

Mary Kate Cary

Mary Kate Cary is a former White House speechwriter for President George H.W. Bush. She currently writes speeches for political and business leaders.

advertisement

Robert Schlesinger

An End to the NRA’s Angry Swagger

Polls show that overwhelming majorities of Americans, and even of NRA members, favor universal background checks.

Mary Kate Cary

Washington’s Toxic Stew

President Obama's burgeoning problems affect more than this week’s three scandals.

Latest Videos

advertisement