Conservative horror stories about Obamacare run amok are finally coming true in the minds of some.
The U.S. Preventive Services Task Force, a government panel of doctors and scientists, concluded on Monday that women in their 40s do not need mammograms. According to the Associated Press, the decision went on to state that women should begin biennial testing at age 50. This is a break from the American Cancer Society’s long-held position, which states that women should seek annual mammograms beginning at age 40, and it has stirred controversy in the medical community.
So this sounds like an open-and-shut case of Obama-style communist health care rationing, right? While we’re sure that some people (you know who) will paint it as such, let’s not jump to conclusions. Early breast cancer diagnosis is critical, but if the health risks and financial costs of testing women under 50 outweigh the benefits, this is a sound decision.
The task force found that early and frequent screenings often lead to false alarms and unneeded biopsies, without significantly improving women’s odds of survival. It argues that the risk of breast cancer in women younger than 50 is very low, but the risk of biopsy complications after false-positive results is too high to recommend mammograms for this group.
These recommendations are also in line with international guidelines, which call for testing to begin at age 50. The World Health Organization suggests mammograms every two years, while Britain says every three years.
So before jumping on the pundit bandwagon, already beginning to portray this as the Obama administration trying to take away health care from those who need it, consider the argument in its entirety.
arpeggio
"you never address the point that the report found no improvement in outcome when starting mammograms at 40 vs 50."
I did. I said that their definition of "improvement" is a mathematical formula that, rather than looking at raw health benefits, weighs it against cost-effectiveness and the potential for excessive treatments (such as biopsies, which are very safe if it turns out there is no cancer, and very important if there IS.)
It's akin to banning medical books for fear that hypochondriacs will put strain on the system.
The fact that it is a "recommendation" and not a mandate means very little for a number of reasons. The first is that insurance companies base their rates and coverage off of industry standards. For the moment, many companies have come forward to say that their rates will not be influenced by this. I doubt the staying power of that commitment. Also,it reveals a very specific mindset and mentality that is likely a precursor to the upcoming public option attempt.
Luckily, there are lawmakers to prevent this. Our very own representative Debbie Wasserman Schultz found her breast cancer via a self breast exam (which the study said was equally worthless) at the old and decrepit age of 41.
To dismiss procedures in large part because of cost, which is the most weighted variable in this equation according to the American Cancer Society (back to the "it saves lives, just not 'enough' of them" quote), is unconscionable...but fiscally sound.
As for me, if you wish to attack the person and not the argument, fine.
You probably do not know this (since you chose to make your argument about it) but prostate cancer is very slow growing. In fact, many of the men diagnosed with it do not die OF it, but WITH it.
While breast cancer can be a fast-growing killer that hits ~1 out of every 200 women before they are 40 (http://www.cdc.gov/cancer/breast/statistics/age.htm),
Prostate cancer is so rare in young men that there ARE NO INCIDENCE STATISTIC IN MEN UNDER 35.
(http://www.prostate-cancer.com/age-prostate-cancer.html)
So yes, the comparison you've made is about as ridiculous as it gets. To say women in their 40s are in as much or more danger from self exams and mammograms as they are from breast cancer is to close your eyes to logic.
I'm not advocating that 12-year-olds check their breasts each week. I am advocating that groups that are WELL WITHIN a high-risk zone ignore suggestions that they not check themselves. And with the stated 1 in ~200 rate of breast cancer by age 40, that is definitely warranted.
It doesn't take a cancer expert to realize that the recommendations are ridiculous.
Then again, since the study lacked even a single oncologist...perhaps it does?
old guy
you never address the point that the report found no improvement in outcome when starting mammograms at 40 vs 50. also keep in mind that this is a recommendation and not a mandate for every woman. women with a family history of breast cancer or other risk factors will still be getting mammograms earlier and more often to catch early cancers.
using your logic, i assume you've been getting monthly prostate exams since high school since theres no risk to a prostate exam? sure its above what the science supports, surely you cant justify saving a life against an invasive procedure.
arpeggio
"...the increased risk of cancers induced by mammography, coupled with the additional cost of biopsies etc. are not worth it."
Again, there is the issue. What weight is being given to the "risk" and what weight to the COST?
There is risk in every procedure, from vaccinations to surgeries. These procedures are still done because the risk is minimal compared to (democrats may recall this phrase) "the costs of doing nothing."
The "Risk" of mammography to the patient is 1~2% chance increase of cancer.
The chance of death is 1 in 2,000.
http://www.sfgate.com/cgi-bin/article.cgi?file=/c/a/2009/11/18/MNLT1ALVJA.DTL
Your panel of experts (not ONE of whom is an oncologist) didn't even find evidence that breast self-examinations save lives. They weigh this against the "harm" of twice as many biopsies.
(http://www.sfgate.com/cgi-bin/article.cgi?file=/c/a/2009/11/18/MNLT1ALVJA.DTL)
Normally, a rational person would not be able to justify balancing lives against what are merely invasive procedures. After all, if there is no cancer, the biopsy poses no additional threat. If there IS cancer, these women may not even detect it for 10 years, if they live that long. Even if they DO detect it through self breast exams, the panel says they are not to be trusted, either.
We cannot honestly be expected to believe such things.
The facts are that 15% of women in their 40s detect breast cancer through mammogram.
http://www.cnn.com/2009/HEALTH/11/16/mammography.recommendation.changes/index.html
But your panel is worried about "anxiety" and "unnecessary biopsies"
Amazing.
I take the American Cancer Society's stance on this:
"With its new recommendations, the [task force] is essentially telling women that mammography at age 40 to 49 saves lives; just not enough of them.”
http://news.medill.northwestern.edu/chicago/news.aspx?id=147353&print=1
As a plus, the ACS even has oncologists!
old guy
arpeggio, there is a cost and risk associated with mammography. it uses ionizing radiation, which can cause cancer, to create the image. the recently released report determined that the increased risk of cancers induced by mammography, coupled with the additional cost of biopsies etc. are not worth it. having annual mammographies starting at age 40 does nothing to improve the outcomes of breast cancer. these conclusions were not made by an accountant, but by scientists and medical practitioners. if youre doing something that costs a lot, both in dollars and emotional trauma associated with a high rate of false positives, but that doesnt improve the outcomes of breast cancer, then it only makes sense to change what youre doing.
arpeggio
First off, I believe in American exceptionalism. I believe international standards have, for a long time now, been brought up to be in line with American standards. I believe we have been at the forefront of standards of living and care for generations.We are the "Joneses" other industrialized countries have to keep up with.
In fact, if you were to dismiss non-health related death rates (i.e. our violent crime rate, our drunken driving deaths, etc) and look at average adjusted life expectancy, ours is the highest in the world. What brings our "life expectancy" totals down is our higher murder rates / accident deaths / destructive lifestyles. Our medical procedures, however, are second to none.
Let's examine the statements in this editorial:
"Early breast cancer diagnosis is critical,"
Yes. It is.
The survivors believe so, at least. Here's their take on the new guidelines:
http://community.breastcancer.org/forum/110/topic/744011?page=10
"...but if the health risks and financial costs of testing women under 50 outweigh the benefits, this is a sound decision."
THAT, right there, is the nugget. That is what turns a "death panel" into a "sound decision" - health risks and financial costs.
What is the health RISK of testing? If testing is too RISKY, then perhaps we should allow mammograms at all! Perhaps breast self exams should be outlawed, because they may "trick" women to seeking "dangerous" care that may or may not be warranted. This is patently ridiculous. It is obviously far more dangerous to wait a decade before you test yourself for cancer. Health is not an issue here. The issue is, as you've said, "financial costs."
You see, while a mammogram does not force someone to get dangerous surgery, it DOES cost money. And with our debt over $12 trillion (http://www.treasurydirect.gov/NP/BPDLogin?application=np) your health is not the first thing on the government's mind. ESPECIALLY when a single-payer option may result in the GOVERNMENT (read: you, the taxpayer) paying for such procedures.
At the end of the day, it is always better to know more than less. It is not the mammogram that kills 40 thousand+ women a year in the US (http://www.cancer.org/downloads/STT/CAFF2005BrFacspdf2005.pdf).
How many women have to be saved for the cost to be "worth it?"
This is the government running numbers on the value of a human life, and finding it expendable for its potential single payer budget.
RainDogGator
To borrow a line from parents everywhere:
If everyone else jumped off a bridge, would you?
If you can make a case for thepolicy change based on real facts and evidence, then by all means do so. But to claim that we in the US should alter our medical practices just to conform to some international standard is absurd.
Compared to most countries, the US is wealthy. As such, we have more disposal income to devote to preventative medicine. Why should we give up this good thing just to conform to other countries (that would probably do the same thing if they could)?