<p>A large, well-conducted randomized trial of almost 100,000 Canadian found that mammograms for women ages 40-59 did not reduce breast cancer mortality. At all. The mammograms didn’t reduce mortality one bit.</p>
<p>The mammograms did, however, cause more cases of breast cancer to be diagnosed. That’s bad, not good! More women underwent treatment for cancer, but just as many women died. In other words, a bunch of women went through cancer treatment for no reason-- if they hadn’t had the mammogram, they wouldn’t have been diagnosed and they would have been fine.</p>
<p>A firestorm of criticism erupted, with accusations of the USPSTF trying to ration medical care, given the then-current debate about medical insurance reform eventually leading to the PPACA. The cultural preference for more medical care (whether or not it improves outcomes), and the providers’ motivations to have people get more medical care, likely added fuel to that firestorm.</p>
<p>I certainly hope that useless mammograms are disincluded from the ACA’s preventative services. But even if the ACA would pay, a woman 40-59 would be foolish to have a screening mammogram. Why expose yourself to radiation for no reason, even if it’s free?</p>
<p>Do those whose cancers are detected by mammogram have a longer life span? I know a number of women who died, but they fought it for years, many finally dying of side effects of treatment after running though so many medications and procedures. But for them, that they got those extra years in, meant , some cases, getting them through high school, on their own two feet. seeing a grandchild. Don’t know how that would be measured.</p>
<p>No. That’s what “does not reduce mortality” means; it means the women in the mammogram regime died at the same rates and with the same lifespans as the women in the no-mammogram regime. More women were treated for breast cancer in the mammogram regime, but larger number of women treated did not translate into longer lifespans.</p>
<p>Notice the trick, though. The women with mammogram-detected breast cancer have longer survival rates: not because they live one millisecond longer, but because their cancer was detected earlier. You can increase survival rates by detecting cancers earlier and doing nothing to treat them (which is pretty much what’s going on with PSA tests).</p>
<p>Frugaldoctor, I’m hoping that doctors will stop recommending mammograms to women under 60, since we now know their only benefit is to radiologists’ incomes.</p>
<p>Is coverage for routine mammograms written into the ACA? If so, it will take an act of Congress to have it removed. I imagine that doctors will continue to prescribe them, as it benefits their bottom line and helps shield them from potential liability. </p>
<p>No, it’s not written into the ACA. The ACA says that preventions rated A or B from the US Preventative Services Task Force have to be free. The USPSTF currently recommends mammograms, but they are updating that recommendation right now. </p>
<p>Insurers will no doubt notice if the recommendation is changed, and stop paying for mammograms.</p>
<p>As noted above, only for women age 50-74, every 2 years (B recommendation). For women age 40-49, the USPSTF has a C recommendation (only for specific cases).</p>
<p>And if this study is accepted, as I would expect it will be (over 80,000 women in a randomized trial is a gold-plated study), then the mammogram recommendation for women 50-59 would be removed, I assume. And then insurers won’t have to offer the service for free.</p>
<p>I remember that firestorm after the 2009 recommendation change. It was like a screening test for innumeracy. </p>
<p>So many people are so afraid of the big C that they’d rather be over diagnosed than under diagnosed. They think that being over diagnosed means that “everything was done” and would feel unserved by the health care system otherwise. It’s a problem, and one that costs a lot of money do be doing so many scans for every little thing. </p>
<p>This is probably true for me, also. I had my first colonoscopy the month I turned 50. The size and type of polyp the doctor removed, while benign, had a good chance of turning cancerous. I am VERY glad I had the colonoscopy, and tell all my friends who are 50 or older that they should get one, also. I had a second colonoscopy a few months after the first one, to make sure the polyp had been completely removed. Insurance paid for both exams, to my surprise (we have crappy insurance since we’re self-employed).</p>
<p>I will just follow my doctor’s recommendation on mammograms when I see her for my annual check-up.</p>
<p>My doctor has been saying that due to my extensive family history I should start having mammograms earlier than usual, though “earlier” has not yet been defined. I assumed insurance wouldn’t pay for it and haven’t really given it any thought at all yet, but it’s at the back of my mind. My grandma had breast cancer when she was my age. She survived, but her two sisters and her mother were all killed by breast cancer. It nearly wiped all the women out on that side of the family. My grandma’s daughter, my aunt, was the first in two generations not to get it. </p>
<p>Is the implication that other methods of checking for breast cancer are just as effective at reducing mortality, or that early detection isn’t making a difference? </p>
<p>The colonoscopy seems to be the one really valuable screening and prevention tool. It can stop cancer before it starts, thus negating the need for all the chemo and radiation. Other screening/early detection schemes just cause expensive, invasive, miserable treatment to start sooner. I hope all the new information on this does not cause people to stop the one procedure that does pay off. </p>
<p>Science is hard. All the early screening was implemented with the best of intentions - if we can catch it and treat it earlier, we have a better chance of curing it. Turns out the ones that can be treated effectively don’t need to be found early, and the ones that can’t be treated effectively aren’t any easier to cure when found early. Who would have guessed? </p>
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