<p>“I worry that the government and insurance companies will use this to deny coverage for women who do want them for peace of mind.”</p>
<p>My peace of mind will be enhanced if I have a full-body MRI at age 21. I’d like our shared insurance pool to pay for that. Your thoughts?</p>
<p>My thoughts: Lack of peace of mind is not a problem oncologists are trained to solve. If it’s severe enough to affect a person’s quality of life, then call in psychiatrists. But oncologists are supposed to treat cancer, not fear of cancer.</p>
<p>We’re not hearing from anyone whose 25th mammogram, at age 65, detected a tumor caused by the previous 24 mammograms. But logically, she’s out there. More than a few.</p>
<p>The US Preventive Services Task Force is not some sort of “Obamacare Panel.” It is an independent panel of experts in primary care put together by the Agency for Healthcare Research and Quality (a Division of HHS, just like NIH). It has been around since 1984. “The USPSTF conducts rigorous, impartial assessments of the scientific evidence for the effectiveness of a broad range of clinical preventive services, including screening, counseling, and preventive medications. Its recommendations are considered the “gold standard” for clinical preventive services.”
[Health</a> Care: U.S. Preventive Services Task Force (USPSTF) Subdirectory Page](<a href=“Clinical Guidelines and Recommendations | Agency for Healthcare Research and Quality”>Clinical Guidelines and Recommendations | Agency for Healthcare Research and Quality)</p>
<p>The are actually very apolitical and science driven – and were specifically asked NOT to consider costs in their recommendations.</p>
<p>I remember well the NIH Consensus Conference on mammography screening for women ages 40-49 held more than 10 years ago. These Consensus Conferences bring in independent panels of experts who are smart and competent scientists/phyisicans but don’t have a “horse in the race” (e.g.they would not have radiologists or breast cancer specialists on the committee). Scientists who are expert in the field present the literature, the panel does an evidence-based review, and they write their recommendations. In the case of the consensus conference 10 years ago, the panel advised that “the data currently available do not warrant a universal recommendation for mammography for all women in their forties. Each woman should decide for herself whether to undergo mammography.” Well, what a ruckus! You would have thought they were sentencing women to death with the reaction of some of the medical and patient communities. The NCI itself was unhappy with the result (because it’s an independent panel, the NIH does not have a say in the conclusions). Read this if you want to see that there’s nothing new under the sun: [Fiddling</a> While Rome Burns: The Latest Mammogram Controversy](<a href=“http://www.locateadoc.com/articles/fiddling-while-rome-burns-the-latest-mammogram-controversy-230.html]Fiddling”>http://www.locateadoc.com/articles/fiddling-while-rome-burns-the-latest-mammogram-controversy-230.html)</p>
<p>So, where does this leave us? As someone who looks at the evidence dispassionately, I think I’m going to start getting my mammograms every other year. For those who want it yearly – don’t worry. This is such a political hot-button issue that I can almost guarantee no one will take away your right to get yearly mammography paid for by insurance for the forseable future. I just feel bad that so many of our decisions – for medical care as well as other aspects of our lives – are based on fear rather than the best scientific evidence.</p>
<p>I agree with Billy P-- I’d love an “excellent, caring physician”. What I have is a clinic where overworked Dr’s and PA’s do their best to minister to far too many people, while trying to keep the place from going bankrupt. It’s true I live in a rural area, but I pay a great deal for health insurance, and get the bare minimum of health care-- mostly from people who hardly know me, and tend to be patronizing and half-informed. (A deadly combination.)</p>
<p>And momof3, I too feel sad that there’s so much suspicion and anger around this issue. I think some of it is caused by the medical community, though-- who often prescribe tests and treatments more in fear of malpractice suits than out of concern for the patient. Life is uncertain and our understanding of health is far from complete-- and we all wish for a guarantee, but there isn’t one.</p>
<p>I think you’re right about this becoming a political hot-button. I had to go out-of-town today and while I was driving home (3+ hours) I decided to switch over to the local talk radio guy. I don’t normally listen to this drivel, but I’d heard the same NPR news stories three times. The view of many callers as well as the host was that this was Obamacare gone wild and a portent of what was to come. In addition, lots of women who’d been diagnosed with cancer in their 40s called in to tell their stories. I haven’t had a chance to read any of the coverage on this (just heard it on the news and here), but do the recommendations also say that self-exams aren’t making a difference either? Lots of talk about that recommendation, which struck me as silly. Who’s gonna stop a woman from going ahead and doing a self-exam if it makes her feel better and gives her some peace of mind.</p>
<p>Just so happens that I had my mammogram and whole breast ultrasound today. From what I overheard in the office today they were getting quite a number of phone calls. The Dr was not happy with the new recommendation. Sounded like she was going to be interviewed this evening for the local news.
My M died of breast cancer. I find that I end up getting a mammogram about every 18 months unless I feel something.</p>
<p><rant on=“”>
This is all about saving money and health care reform. It has nothing to do with taking care of women’s health <em>sigh</em>
</rant></p>
<p>^ I’m not sure what “this” you are referring to, but it might be interesting to know what MD’s are doing for their own health. I bet you won’t find them doing stuff that has limited if any value. Bet you won’t find too many of them smoking. May not save a lot of health care dollars, but they don’t want to go out like that…</p>
You can rant and sigh, but it simply isn’t true. This is about evidence-based decisionmaking. For example, two large studies showed that self-exam had no impact on mortality. Impact of mammogram before 40 also had little effect on mortality. Some oncologists think that what is going on is that mammograms and self-exams don’t find the kinds of breast cancer that are most likely to be fatal.</p>
<p>So why are “saving money” and “taking care of women’s health” mutually exclusive propositions? If certain common procedures are actually a waste of money, altering those procedures frees up money that can be used productively–for women’s health, children’s health, fetal health, and so on.</p>
<p>Health-care funds are limited, obviously. Wasting limited resources does not contribute to improved health.</p>
<p>I have not looked into the specific studies that form the basis of this new recommendation, but very generally speaking:</p>
<p>If you get a bunch of doctors together and ask them to come up with a recommendation, the tendency will be to recommend something that ends up increasing revenue for doctors, and reduces the risk of being sued. That is how we get very aggressive recommendations for PAP smears, mammograms, PSAs, colonoscopies, and all sorts of tests. The testing increase revenue directly and it also provides justification for more aggressive interventions- a polyp removed, a prostate biopsied, a hysterectomy performed- all with valid justification, but none that would have been possible without those screening tests.</p>
<p>Given this background, if a bunch of doctors actually reverse themselves and issue less aggressive guidelines, you can be pretty sure they have considered the data very, very carefully and reluctantly come to the conclusion that their prior recommendations simply cannot be justified in good conscience. Doctors don’t give up revenue-generating opportunities so easily.</p>
<p>The members on this panel have served for years - the chair and vice chair were on the panel when Bush was president. I haven’t looked at the background of the others, but they are not political appointments. This work was going on before health care reform was a glint in Obama’s eye.</p>
<p>Mammograms are not as safe as most think. There is another much safer test using thermography. Mammography could be used when considered appropriate for women 50 and older. Annual thermography screening is for women of all ages.</p>
<p>I have worried about the dangers of cumulative radiation, I must admit. But I don’t understand the “don’t self examine” recommendation.</p>
<p>I read recently about a woman who discovered a lump the size of a lemon. How she missed that I’ll never know. On me it would be like a 3rd breast. :eek:</p>
<p>It is not just radiation of Mammograms that is dangerous. They said that jamming breast can actually spread cancer cells out of very small and contained spot in breast that could have been taken care by body without any medical procedures. Our body actually can take care of itself if given a chance.</p>
<p>I thought that sort of thinking went out in the 60s…when they used to ask women with breast cancer if they remembered getting hit by a softball or volleyball, for instance. That was one rationale for not letting women play sports.</p>
<p>They didn’t know what they were doing then and I don’t think they know now either.</p>
<p>I don’t think there’s a “don’t self-examine” recommendation. I think the finding is that self-examination does not do much good. No one is trying to stop women from self-examining.</p>
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<p>Also, I imagine, that when mammograms and self-exams DO find the kinds of breast cancer that are most likely to be fatal, the available treatment options aren’t effective to stop it. No one is suggesting that women in their 40s don’t get breast cancer. The issue is that mass screening to get early detection doesn’t actually change outcomes, except perhaps in a tiny number of cases.</p>
<p>The American Cancer Society has been promoting early detection essentially since its foundation. There has never been any data to show that it made a difference.</p>
<p>As for politics, I imagine Obama and his supporters are extremely upset about this, precisely because people WILL associate it with him and health-care reform. Anyone who lives near New Jersey knows that about-to-be-ex-Governor Corzine got a lot of mileage in the election out of accusing his opponent of wanting to let insurance companies limit mammograms, and that Christie had a whole ad doing nothing but talking about how he would never stop women from getting mammograms. I assume that both campaigns’ focus on that issue was driven by research that showed it was a hot-button for voters (and Corzine’s team had a lot of overlap with Obama’s team). Politically, there is no way this can be anything but a disaster for Obama, and I’m sure he knows that.</p>