Feds to women in their 40s: Skip the mammogram; Update: Meet the task force

posted at 10:55 am on November 17, 2009 by Ed Morrissey

What a difference six months — and a health-care overhaul proposal — can make!  Just six months ago, the U.S Preventive Services Task Force, which works within the Department of Health and Human Services as a “best practice” panel on prevention, sounded a warning signal over a slight decline in annual mammograms among women in their 40s.  In fact, they warned women of this age bracket that they could be risking their lives if they didn’t get the annual preventive exam (via HA reader Devil’s Advocate):

The downward trend, however slight, has breast cancer experts worried. Mammograms can enable physicians to diagnose the disease at early stages, often before a lump can be felt. “When breast cancer is detected early, it often can be treated before it has a chance to spread in the body and increase the risk of dying from the disease,” says Katherine Alley, medical director of the breast health program at Suburban Hospital in Bethesda.

The U.S Preventive Services Task Force, an independent panel of experts working under the Department of Health and Human Services, recommends that women older than 40 get a mammogram every one to two years. The task force finds the test most helpful for women between ages 50 and 69, for whom it says the evidence is strongest that screening lowers death rates from breast cancer. Other groups, including the American Medical Association, suggest a more rigorous schedule, saying the test should be done every year; insurers often pay for annual tests.

But experts say they are seeing gaps beyond two years in many cases. Carol Lee, chair of the American College of Radiology’s Breast Imaging Commission and a radiologist at the Memorial Sloan-Kettering Cancer Center in New York, says many women understand that they need to have a mammogram but don’t go back for repeat tests after the first one. In Bethesda, Alley said she has even heard anecdotal reports of breast cancer survivors forgoing recommended mammograms.

But today, that same panel says … never mind:

“We’re not saying women shouldn’t get screened. Screening does saves lives,” said Diana B. Petitti, vice chairman of the U.S. Preventive Services Task Force, which released the recommendations Monday in a paper being published in Tuesday’s Annals of Internal Medicine. “But we are recommending against routine screening. There are important and serious negatives or harms that need to be considered carefully.”

Several patient advocacy groups and many breast cancer experts welcomed the new guidelines, saying they represent a growing recognition that more testing, exams and treatment are not always beneficial and, in fact, can harm patients. Mammograms produce false-positive results in about 10 percent of cases, causing anxiety and often prompting women to undergo unnecessary follow-up tests, sometimes-disfiguring biopsies and unneeded treatment, including surgery, radiation and chemotherapy.

But the American Cancer Society, the American College of Radiology and other experts condemned the change, saying the benefits of routine mammography have been clearly demonstrated and play a key role in reducing the number of mastectomies and the death toll from one of the most common cancers.

“Tens of thousands of lives are being saved by mammography screening, and these idiots want to do away with it,” said Daniel B. Kopans, a radiology professor at Harvard Medical School. “It’s crazy — unethical, really.”

What changed in six months to change the USPSTF from a sky-is-falling hysteric on a 1% decline in testing to Emily Litella?  If the administration gets its way, the government will be paying for a lot more of these exams when ObamaCare passes.  That will put a serious strain on resources, especially since many of the providers will look to avoid dealing with government-managed care and its poor compensation rates.

The motivation for HHS will be to cut costs, not to save lives.  The sudden reversal in six months of the USPSTF, especially after it made such a stink over a relatively minor decline in screening, certainly makes it appear that they have other priorities than life-saving in mind here.

One final thought.  Barack Obama predicated his ObamaCare vision on the notion that increased prevention would save costs.  Suddenly, his administration is for decreased screening and prevention.  Could that have anything to do with the CBO scoring on screening?  And what does that say about how government will make decisions once they control the compensation and care in the US?

Update: Courtesy of an anonymous reader, here are the members of the US Preventive Services Task Force.  See if you can figure out the one thing they all have in common:

Current members of the Task Force are listed below. They have recognized expertise in prevention, evidence-based medicine, and primary care.

Bruce N. Calonge, M.D., M.P.H. (Chair)
Chief Medical Officer and State Epidemiologist
Colorado Department of Public Health and Environment, Denver, CO

Diana B. Petitti, M.D., M.P.H. (Vice Chair)
Professor of Biomedical Informatics
Fulton School of Engineering
Arizona State University, Tempe, AZ

Susan Curry, Ph.D.
Dean, College of Public Health
Distinguished Professor
University of Iowa, Iowa City, IA

Allen J. Dietrich, M.D.
Professor, Community and Family Medicine
Dartmouth Medical School, Hanover, NH

Thomas G. DeWitt, M.D.
Carl Weihl Professor of Pediatrics
Director of the Division of General and Community Pediatrics
Department of Pediatrics, Children’s Hospital Medical Center, Cincinnati, OH

Kimberly D. Gregory, M.D., M.P.H.
Director, Maternal-Fetal Medicine and Women’s Health Services Research
Cedars-Sinai Medical Center, Los Angeles, CA

David Grossman, M.D., M.P.H.
Medical Director, Preventive Care and Senior Investigator, Center for Health Studies, Group Health Cooperative
Professor of Health Services and Adjunct Professor of Pediatrics
University of Washington, Seattle, WA

George Isham, M.D., M.S.
Medical Director and Chief Health Officer
HealthPartners, Minneapolis, MN

Michael L. LeFevre, M.D., M.S.P.H.
Professor, Department of Family and Community Medicine
University of Missouri School of Medicine, Columbia, MO

Rosanne Leipzig, M.D., Ph.D
Professor, Geriatrics and Adult Development, Medicine, Health Policy
Mount Sinai School of Medicine, New York, NY

Lucy N. Marion, Ph.D., R.N.
Dean and Professor, School of Nursing
Medical College of Georgia, Augusta, GA

Joy Melnikow, M.D., M.P.H.
Professor, Department of Family and Community Medicine
Associate Director, Center for Healthcare Policy and Research
University of California Davis, Sacramento, CA

Bernadette Melnyk, Ph.D., R.N., C.P.N.P./N.P.P.
Dean and Distinguished Foundation Professor in Nursing
College of Nursing & Healthcare Innovation
Arizona State University, Phoenix, AZ

Wanda Nicholson, M.D., M.P.H., M.B.A.
Associate Professor
Johns Hopkins School of Medicine and Bloomberg School of Public Health, Baltimore, MD

J. Sanford (Sandy) Schwartz, M.D.
Leon Hess Professor of Medicine, Health Management, and Economics
University of Pennsylvania School of Medicine and Wharton School, Philadelphia, PA

Timothy Wilt, M.D., M.P.H.
Professor, Department of Medicine, Minneapolis VA Medical Center
University of Minnesota, Minneapolis, MN

What do they have in common?  There isn’t a single oncologist among them, at least not as a listed specialty by the USPSTF published roster.


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Comment pages: 1 2 3 4

Yessir, dave isn’t letting one thing slip by him tonight. Be sure to check his links…the source articles present a slightly different picture than the one he is trying to shove down our throats. note to dave…find some research more recent than 1997…stop spending money on worthless task forces with a political axe to grind…decrease HHS budget by 95%…our country is BROKE!

indypat on November 17, 2009 at 9:02 PM

Death Panels.

jimmy2shoes on November 17, 2009 at 9:06 PM

Dr Daniel Kopans, professor of radiology at Harvard Medical School in Massachusetts, said the new guidelines are ‘scientifically unjustified and will condemn women ages 40 to 49 to unnecessary deaths from breast cancer’.

Read more: http://www.dailymail.co.uk/news/worldnews/article-1228536/American-women-face-cancer-dilemma-told-Dont-bother-mammograms-50.html#ixzz0XAlx2pRE

indypat on November 17, 2009 at 9:08 PM

daesleeper:

Reducing the value of human life to a dollar amount.

I guess we’re lucky that insurance companies don’t do that. If you knew the first thing about public health. you would know that this is done routinely. Even the great US of A.

indypat:

find some research more recent than 1997

The study from Norway that found that people getting regular mammograms got 22% more cancers was from 2006. Note to indypat: maybe you should read some scholarly literature instead of HA.

dave742 on November 17, 2009 at 9:58 PM

Daniel Kopans, professor of radiology at Harvard Medical School in Massachusetts, said the new guidelines are ’scientifically unjustified and will condemn women ages 40 to 49 to unnecessary deaths from breast cancer’.
Read more: http://www.dailymail.co.uk/news/worldnews/article-1228536/American-women-face-cancer-dilemma-told-Dont-bother-mammograms-50.html#ixzz0XAlx2pRE
And what was the date on that other study you quoted? Was it…1997? We’ll keep our healthcare, you can take your change and …

indypat on November 17, 2009 at 10:18 PM

Just like everything else with Nobama: expiration date and the Ministry of Truth rewriting history.

HAnthonyWayne on November 17, 2009 at 10:19 PM

Tell that to my wife who had her breast cancer detected by a mammogram she insisted on. Fortunately she wasn’t listening to the bunch or morons!

flytier on November 17, 2009 at 10:20 PM

Death Panels.

jimmy2shoes on November 17, 2009 at 9:06 PM

+

Johan Klaus on November 17, 2009 at 10:27 PM

dave742 on November 17, 2009 at 2:30 PM

Do you or would you go to England or Canada for your healthcare?

Johan Klaus on November 17, 2009 at 10:32 PM

It’s NOT a death panel. It’s an end-of-life panel.

Idiots!

Mojave Mark on November 17, 2009 at 10:32 PM

I would like to know when this panel was appointed and by whom. Their party affiliation would be nice too. Guess that’s not important by the lamestream media.

Oh, the panel can go to hades from me too. I was diagnosed and saved when I was 40.

PattyJ on November 17, 2009 at 10:41 PM

dave742, It seems to me to be more nefarious when it is done by government. Rationing(ie. setting the price) by the nameless and faceless bureaucrats who have lifetime political appointments and the monopoly of force to dictate what I can and cannot have is evil.

I am sure you disagree.

daesleeper on November 17, 2009 at 10:41 PM

This panel makes no sense unless it is trying to kill off more women. What next prostate cancer? Umm the cancer that doctors call the waiting cancer (wait and you will get it) let not test that either or wait til men are 90 before we test so we can kill off a bunch before we have to pay for it. What scary is that the House passes a bill and this comes out within 2 weeks.
By the way how will this play with Democratic womene that were so worried about women health during the Health Care debate in the House. I am sure that the women that were so damn worried if a woman has a right to an abortion will be so concerned about this. /sarc

Gracelynn on November 17, 2009 at 11:25 PM

What do they have in common? There isn’t a single oncologist among them, at least not as a listed specialty by the USPSTF published roster.

This simply must be the least intelligent statement Ed has made in his Hot Air career. (We all make dumb statements, so don’t say I’m hating on Ed.) An epidemiologist, like the chair of the commission is, is far more qualified by profession to judge the usefulness of mammogram testing than an oncologist is. But, in the end, any smart person willing to think through a cost-benefit analysis of mammogram testing is as qualified as any other to make a judgment on this issue–be they an epidemiologist, an art history professor or a janitor.

thuja on November 17, 2009 at 11:39 PM

Just last month, the white house was draped in pink to remind women to follow up on breast cancer exams. Of course that was prior to the House passing healthcare bill….

TN Mom on November 18, 2009 at 12:47 AM

Dr. Utopia prescribes Hope & Change: Hope you live & if not you’ll change.

BHO Jonestown on November 18, 2009 at 1:15 AM

that makes me want to vomit
these individuals ought to be stripped of their jackass titles and not be permitted to practice medicine except on each other.

ocbrat on November 18, 2009 at 1:36 AM

http://www.veteranoutrage.com

I mean come on folks
literally 12 months ago womens groups were still being told
get mammograms for womens health..

and it made sense..

Now all of a sudden obama and all these same liberal groups are telling women
awwa just foget about it..

dont bother..

yep this is definatly the beginning of rationing..
and obama care isnt even passed yet..

oh man you liberals are in for on hellava hangover..
as soon as its signed i guarantee you within 6 months
halft the employees in the entire usa will loose their health insurance..

and as all of these pile into a government run doctor system with the compasssion of the IRS
well i can imagine a lot of people getting just pissed off that their old doctor now has a 6 month waiting list just to get an appointnment..

Ohh brother you asked for it
you got it
nazi err obama care..

veteranoutrage on November 18, 2009 at 1:58 AM

Oh ok, eliminatng preventive medicine is cheaper huh. yep ok. I get it now. Promote sickness and dying. Its the American Way. uh…NO!

johnnyU on November 18, 2009 at 4:44 AM

Tell that to my wife who had her breast cancer detected by a mammogram she insisted on. Fortunately she wasn’t listening to the bunch or morons!

flytier on November 17, 2009 at 10:20 PM

Sent a little prayer up for her. God bless.

jimmy2shoes on November 18, 2009 at 6:05 AM

I saw a debate by a member of this panel and a doctor who opposed their findings on CNN last night. This panel needs to pick a different spokesperson. To say she was unimpressive would be an understatement.

Cindy Munford on November 18, 2009 at 7:41 AM

i question the timing of the panels recommendation. Imagine the uproar this would have caused if released during breast cancer awareness month. It would also have been fatal to Obama/Pelosicare.

I think that this is not the first incident of health care rationing. The first is the swine flu vaccine disaster.

Fire Sebelius.

docshund on November 18, 2009 at 8:00 AM

I’m just waiting for them to tell us that we don’t need those pap smears. Every 5 years ought to be enough – think of the money we will save.

Ellen on November 18, 2009 at 8:02 AM

I\’d like to say something sarcastic, I mean, mammograms are no fun, but this is serious. I know too many people, close to my age who have been diagnosed with breast cancer, so I appreciate the fact that I can get one every year.

4shoes on November 18, 2009 at 8:15 AM

And…that 98 billion in wasted tax dollars mentioned on another thread will more than pay for everyone who wants one to get a screening with money left over. sarc/

jeanie on November 18, 2009 at 8:38 AM

The majority of the panel work for government or universities.

durhamite on November 18, 2009 at 8:55 AM

Johan Klaus:

Do you or would you go to England or Canada for your healthcare?

I don’t, because I live in the US. If I moved to Canada or the UK, I would be happy to use their system. First of all, on a personal level, I have never been impressed by the level of care that I or my family and friends have received here. By moving to Canada or the UK, I would get better health care at a far cheaper price. I don’t see the downside in that. Every study I have ever seen comparing level of care in first world countries has the US at or near the bottom.
On a national level, the benefits are even greater. I don’t enjoy being part of a system that allows tens of millions of people to go without insurance, and allows 20,000 people a year to die because of it. It makes me feel immoral to be part of a country that does that. I would rather be part of a country with a system that cares for its people. I’m weird that way.

dave742 on November 18, 2009 at 8:58 AM

daesleeper:

It seems to me to be more nefarious when it is done by government. Rationing(ie setting the price) by the nameless and faceless bureaucrats who have lifetime political appointments and the monopoly of force to dictate what I can and cannot have is evil.

It’s either the government or insurance companies who decides. When a fat, rich, old, white, executive of an insurance company has a decision to make regarding providing more coverage (and decreasing profit) vs providing less coverage (and increasing profit), I have little doubt what choice he will make. With a politician, at least if he fights for more coverage he can use that to get re-elected. He has some incentive to do the right thing. To the extent that a polician will not do the right thing is proportional to the extent that he and his decisions are owned by the insurance (and pharma) companies. Get rid of the insurance companies, and you get rid of a big incentive politicians have to do the “evil” thing.

dave742 on November 18, 2009 at 9:12 AM

Women, be patriotic.

Illegal aliens who hate our country need health care.

And we have to pay for it somehow.

Really, a few thousand of you may die by not having early mammograms, but think of the millions who will get their sniffles treated because of your sacrifice.

How can you not do it!!

notagool on November 18, 2009 at 10:28 AM

Still don’t think the death panel mechanism is starting to turn? If you’re under 50, your insurance won’t cover a mamogram? Hey ladies…. you can sacrifice for the economy can’t you?

kens on November 18, 2009 at 12:55 PM

I am sure that the women that were so damn worried if a woman has a right to an abortion will be so concerned about this. /sarc

Gracelynn on November 17, 2009 at 11:25 PM

Especially, IIRC, women who had abortions are at higher risk of breast cancer

AH_C on November 18, 2009 at 6:59 PM

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