Tuesday, November 17, 2009

Gov't Task Force: Mammography for Fortysomethings Saves Lives, Just Not Enough to Justify the Cost$$ & Stress

It’s about money, these new recommendations unveiled yesterday by a federal task force which tell women between the ages of 40-49 that, unless they know that they have the breast cancer gene or have had extensive chest radiation, there’s no need for them to get mammograms.

You see, even though there’s data which says that women’s lives ARE SAVED by preventative screenings, such regular screenings of fortysomething women (particularly those with dense breast tissue) cause those women angst because they’re oftentimes told to come back for more screenings or require a biopsy when, most of the time, those women don’t have breast cancer. The angst caused by mammograms and those biopsies which don’t turn up cancer aren’t worth the risk of screening fortysomething women for cancer, the government task force says. That, and the fact that it’s all about the money.

The New York Times summarized the US Preventative Services Task Force's (USPSTF) new mammography guidelines (which, it's not hard to envision, being adopted by health insurance companies) saying:

“Over all, the [USPSTF] report says, the modest benefit of mammograms – reducing the breast cancer death rate by 15 percent – must be weighed against the harms. And those harms loom larger for women in their 40s, who are 60 percent more likely to experience them than women 50 and older but are less likely to have breast cancer, skewing the risk-benefit equation. 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 74, and one death for every 377 women age 60 to 60.”
 
Aw, what’s the big deal if you ONLY reduce the death rate of fortysomething women by 15 percent with regular mammograms? Why make all those other fortysomething women so very nervous with biopsies when they likely don’t have cancer. It’s too much bother. That, and it’s all about money. And if you’re a woman who's 75 or older, you don’t need the screening ‘cause the task force thinks you’re too old and you’re likely to die from something else so they don’t want to waste money screening you anymore.

Twice, during my own experience getting mammograms (two members of my family have had breast cancer), I experienced some angst when I had to come back for another mammogram or get an ultrasound to check out a suspicious area, but I was wildly relieved when I got the all clear. I’d rather live with the anxiety experienced while awaiting test results and for a negative biopsy to learn that I DON’T have breast cancer than roll the dice that I’ll never get it, at least when I’m in my 40s, because a government panel doesn’t think it’s likely that I have it.

The New York Times explained what the task force members saw as the downside of regular mammograms for women in the fortysomething age group:

“While many women do not think a screening test can be harmful, medical experts say the risks are real. A test can trigger unnecessary further test, like biopsies, that can create extreme anxiety. And mammograms can find cancers that grow so slowly that they never would be noticed in a woman’s lifetime, resulting in unnecessary treatment.”

I guess a fortysomething woman can avoid the horrid and "real" side effect of "extreme anxiety" from having to go back for a second mammogram or having a biopsy if she’s already dead because she was unlucky enough to develop breast cancer when she was in her 40s. She’d certainly save lots of money for the bottom line. (I think I’d have more anxiety if I were being audited by the IRS than I've had while sitting in the mammogram waiting room.)

Many doctors and breast cancer specialists quoted by news outlets today are livid.

Dr. Daniel B. Kopans from Massachusetts General Hospital Cancer Center told the Boston Globe that the task force’s recommendations “will condemn women ages 40-49 to unnecessary deaths from breast cancer.”

Dr. D. David Dershaw, a mammography specialist at New York’s Memorial Sloan-Kettering Cancer Center, likewise, put it bluntly to the Globe saying:

“How many cars do you have to put seat belts in to save a life? How many colons do you have to screen in order to save a life? How many people do you have to immunize for the flu in order to save a life? These numbers are totally within the acceptable range of what we routinely do as part of a civilized society.”

The American Cancer Society says on its web site that, after examining the same data used by the federal task force, that their organization continues to recommend regular mammography for women starting at age 40 because “lifesaving benefits of screening outweigh any potential harms.”

It continued:

“With its new recommendations, the USPSTF is essentially telling women that mammography at age 40 to 49 saves lives; just not enough of them. The task force says screening women in their 40s would reduce their risk of death from breast cancer by 15 percent, just as it does for women in their 50s. But because women in their 40s are at lower risk of the disease than women 50 and above, the USPSTF says the actual number of lives saved is not enough to recommend widespread screening.”

Most poignant have been the personal stories of women -- those with no family history of breast cancer -- who were diagnosed with breast cancer in their 40s who say they wouldn’t be here but for mammograms.

The Times quoted a now 54-year-old Manhattan woman who found out she had breast cancer when she was 48 after getting an annual mammogram: “You’re going to start losing of a lot women. I have two friends in their 40s who were just diagnosed with breast cancer. One of them just turned 41. If they had waited until she was 50 to do a routine mammogram, they wouldn’t have to bother on her part – she’d be dead.”

Bottom line: It’s about money. It should be about lives.

A prediction: These recommendations, issued by a panel established by the federal government to create standards for medical care, will help to kill, or seriously wound, the attempts to federalize the health care system, especially when that panel says that saving a fortysomething from breast cancer through routine screening is only considered a “modest” benefit and that her life isn’t worth the cost.

2 comments:

Janice and Jessica said...

I am having a biopsy on Friday and although I'm having great angst with the waiting, this article is causing me even more stress. I guess since I'm 46 I'm not worth potentially saving. I bet they don't change the guidelines for men getting a PSA, but of course we all know testicles are so much more important than breast. (said with great sarcasm)

nedell said...

The sarcasm would have best been saved. First, prostrate cancer isnt about testicles. Learn what it is that you are criticizing.
Second, they have already basically said testing for most men is not showing a benefit and for those men over 75 years old, absolutely not necessary.

"The USPSTF concludes that for men younger than age 75 years, the benefits of screening for prostate cancer are uncertain and the balance of benefits and harms cannot be determined.

For men 75 years or older, there is moderate certainty that the harms of screening for prostate cancer outweigh the benefits."
http://annals.highwire.org/content/149/3/185.full

And then you need to know that this statistical basis is what will be guiding the Democrat health plans. An individual will mean nothing unless they are part of the poltical elite, so get ready to be 'not worth potentially saving.' No potential at all; they are telling you outright that you are not worth saving.