Friday, November 20, 2009

First They Came for the Mammograms….

There’s been a great deal of consternation over the last few days about the US Preventive Services Task Force recommending new guidelines for breast cancer screening and evaluation. Essentially, the task force recommends that routine screening begin at age 50 and is probably statistically useless after 75 or so. They further suggested that breast self-examination is so unreliable that women shouldn’t bother.

The history of when to begin screening women for breast cancer has a long history, as noted by ABC News. The guidelines have shifted over the years depending on what the latest studies showed.

It’s also important to understand that conflicting findings are very common in all forms of research and often leave the public confused or increasingly unwilling to believe in the accuracy of any research findings at all.

The task force’s report, however, concerns me for two other reasons.

First, the recommendations are based on statistical significance. All that means is that across all women, the most likely age for getting breast cancer is around 50 or older. Also, across all women, screening after 75 is not recommended because, statistically, they are near the end of their lives anyway.

See the shift? Breast cancer intervention based on probability, not individual medical needs.

Second, the recommendations will inevitably lead insurance companies to adopt the guidelines, which are obviously in their favor, because they can justify not paying for mammograms for women younger than 50 or older than 75. And if insurance companies know anything at all, it’s about probability and statistics.

Which brings us to rationing. The US Senate will debate its healthcare monstrosity tomorrow. Aside from all the other spending-into-oblivion by the current administration, the money to be spent in this bill will inevitably result in needed medical care far, far outstripping the resources to pay for it.

Decisions will have to be made. Some will get breast cancer screening, others will not. Guess what this will mean for your 76 year-old mother?

But the Obama administration didn’t wait for the prestigious semi-independent US Preventive Service Task Force. They have already set up an official government mechanism for using research to justify rationing: The Federal Coordinating Council for Comparative Effectiveness Research Membership.

A whole new bureaucracy to tell us what care we may or may not get by telling us that the “research” has made it so.

The government giveth, the government taketh away.

5 comments:

Jude said...

I wasn't sure how to contact you so I am just leaving a comment.

I thought you might be interested in this. I don't know if you've heard about it yet. Scary stuff!

http://www.dailymail.co.uk/news/worldnews/article-1230092/Patient-trapped-23-year-coma-conscious-along.html

I've never heard of this website so I'm just assuming it is a legitimate story.

jannmoe@gmail.com

Anonymous said...

yes a whole new beuracracy to analyze interpret and manage data for use. not again. this is not what tax payer dollars are for. actually, they are. the whole point of a government is to govern. and what will some one's seventy six year old mother say? how aboutr i'm glad that the screening targets likely individuals to develop breast cancer so if i do develop such a malady, i will not have to compete with those who where without prevenative medicine when they most needed it. of course the governmet uses statistics and probability. it is called risk adjustment. when problems arise or are forseeable, precautions are taken. yes all the probability means is that those who are most suseptiable for breast cancer are agwe fifty. that is the group that needs the care. individual treatment is based off of generalities in order to reduce waste and prevent patient fatalities due to excessive treatment. when will the groundless accusations of orwellian exsistence stop? enough with the dramatizations. premptive stratagies are important, and beneficial to providing codes of conduct and medicinw and treatment that will actually help, not just placate the patient.

Jude said...

Well, although there are many problems with what you've said "anonymous" - one is, that because of this the Ins. companies are going to get a pass to not pay for mammograms if you don't fit into this new criteria. And how can your grandmother even find out that she has breast cancer in the first place? It won't be from a mammogram.

I will not go point by point with everything you said because I never take anyone seriously who has a lot to say but says it all anonymously.

Virginia Beach said...

Jude, thanks so very, very much. Contact me at markpmostert@gmail.com

Let;s chat soon!!!!

Terri said...

I have been deciding about whether to post on this because I don't usually post on things like cancer...

I remember being in a big discussion about Breast Self Exam and Mammograms back in the early 90s. I worked with a group of physicians who would say to women, "Did you do BSE?" or "Did you have regular mammograms?" and shake their heads and tsk at them if they hadn't as if they were responsible for the poor shape they were in now. Patients were devastated by that approach.

The nurses I worked with and I staged a coup. We asked the MDs to meet with us and asked them to stop blaming their patients since BSE and mammograms, to that point, had not been proven to save a single life. The MDs had no idea that that's how they were being received by the patients.

All this to say that these study results are not new... or wrong. What this information should spur is different research approaches (not rationing) since screening is not enough and never has been.

At the same time, my mother died of breast cancer which she discovered with BSE. Indeed, finding the tumor early did NOT save her life, but I believe that it did give us several more years with her. Something that matters also.