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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Newsflash: Sarah Palin is on the Rush Limbaugh radio show right now!!

Dire Straits on November 17, 2009 at 1:23 PM

The issue of radiation-induced cancers is beginning to get more attention lately. I think the risk from a single mammogram to a 40 year old female is pretty low. But I have recently read an analysis showing that for toddlers with a bump on their head, approximately one patient will die from radiation-induced cancer for every 1,000 CT scans done. The child has a more susceptible physiology and has longer to develop a malignancy, and the CT carries a much higher dose of radiation.

Young women who get CT scans of the chest to rule out pulmonary embolism when they present with chest pain and shortness of breath present a difficult decision, as that dose of radiation to the breast may well cause trouble down the road.

mikeyboss on November 17, 2009 at 1:24 PM

I’m surprised most of you guys aren’t thrilled with this. It’s something that will help the insurance companies and isn’t that whose side we’re on? It gives them reason to drop that from coverage and you can bet your booty that they will.
Let’s not be silly and suddenly pretend we care about how many people may die.

fastestslug on November 17, 2009 at 1:24 PM

I’m surprised most of you guys aren’t thrilled with this. It’s something that will help the insurance companies and isn’t that whose side we’re on? It gives them reason to drop that from coverage and you can bet your booty that they will.
Let’s not be silly and suddenly pretend we care about how many people may die.

fastestslug on November 17, 2009 at 1:24 PM

Nice, so even when the liberals make it clear they have no compassion, it’s the conservatives’ fault.

TTheoLogan on November 17, 2009 at 1:34 PM

jeanie on November 17, 2009 at 12:02 PM

Don’t paint with such a broad brush, I have found two that had to be removed because of family history. Today they would just do a puncture biopsy. While it is true that woman may never feel a cancerous lump why take the chance with what they do find?

Cindy Munford on November 17, 2009 at 1:35 PM

fastestslug on November 17, 2009 at 1:24 PM

Four words: federal control, brainwashed voters.

And ‘help’ this could possibly give the industry will end up being quickly negated by meddling, ignorant bureaucrats who have the backing of the bought-and-paid-for leeches they call constituents.

Dark-Star on November 17, 2009 at 1:36 PM

fastestslug on November 17, 2009 at 1:24 PM

Wow, does the work projection mean anything to you?

Cindy Munford on November 17, 2009 at 1:36 PM

I’m going to withhold opinion until i see Dr Hasan’s endorsement.

MaiDee on November 17, 2009 at 1:36 PM

Just from a quick peruse on the MSM this is not being spun well for Obama. Unless you are an extreme leftist kool-aid drinker, I don’t see how you support this.

angryed on November 17, 2009 at 1:37 PM

Not one oncologist or SURGEON.

nor on November 17, 2009 at 1:40 PM

Where are the trolls?

Knucklehead on November 17, 2009 at 11:29 AM

Where’s AnninCA?

I think she’s in hiding, after her smackdown yesterday by Ed and several HotAir commenters.

UltimateBob on November 17, 2009 at 11:33 AM

No, no, no. Not enough Sarah Palin threads. Wait for AP to start posting. He’ll create a more conducive environment for AnnInCA.

tom on November 17, 2009 at 1:40 PM

UltimateBob on November 17, 2009 at 11:33 AM
Wait, i had to work yesterday… :( I missed a smack down of AnninCa by Ed? What thread?

red131 on November 17, 2009 at 1:52 PM

gwelf:

taking the decision out of the hands of patients and doctors and putting it in the hands of bureaucrats

Your health decisions are presently in the hands of insurance companies. I don’t know why that makes you feel so good.

JJKRN:

mammograms do not cause cancer

Ionizing radiation is a non-threshold carcinogen. There are individuals who get cancer from mammographies, just as there are people who get cancer from background radiation.

how bout 22% more cancers detected due to FREQUENT SCREENING

No. That’s not what the study found. The study I showed found 22% more cancers in those who were screened frequently, even among women over age 50. Show me your study where 22% more cancers were detected in women in their 40′s due to mammographies.

jeanie:

Their choices should be honored too.

What does this mean? If you are in your 40′s, your mammography should be paid for? What about women in their 30′s? Should their choice also be honored. Aren’t we already “rationing” mammographies when it comes to women in their 30′s? There is no medical system in the world where a person’s “choice” is honored. My choice is to get the same physical every year that the president gets. I don’t think my health insurance company will honor my choice, however.

dave742 on November 17, 2009 at 1:57 PM

Calling Dr Obama, Dr. Curly, Dr Larry , Dr Moe

Please report ot the ER

bluegrass on November 17, 2009 at 2:07 PM

I’m going to withhold opinion until i see Dr Hasan’s endorsement.

Could not have said it better! But let’s add Drs Mengele and Kavorkian to our little panel!

Dread Pirate Roberts VI on November 17, 2009 at 2:08 PM

Same thing applies to Prostate Cancer. Through a PSA test my Prostate Cancer was found and diagnosed when I was 44. It was localized in the Prostate because it was found early and after the Prostate was removed I was cured. Now under ObamaDontCare the age is 50 for the PSA test. Instead of being 56 I would be DEAD. Excuse me while I order more .40 ammo for my Glock 23.

bill30097 on November 17, 2009 at 2:13 PM

where da trolls at?

angryed on November 17, 2009 at 11:58 AM

Avoiding the potential subject of death panels.

tom on November 17, 2009 at 2:17 PM

Ed,
Please see this article, “No Mammogram Screening For Healthy Women Until 50: It’s about time” by WM Briggs, a conservative leaning PHd statistician. He spells out the problem with mammograms and criticizes conservatives who see this recommendation only as precursor to government rationing. All of your readers would learn a lot about their track record and credibility in detecting real cancer from this discussion and his other articles. Thanks.

mbabbitt on November 17, 2009 at 2:19 PM

dave742: The decision should be between the woman in question,her doctor and her own assessment of what is right for her. Insurance companies and the government are not welcome parties to the choice and should not/never be.

jeanie on November 17, 2009 at 2:21 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.

Insult to injury: Diana B. Petitti, being a professor of “Biomedical Informatics,” is effectively an IT guru who happens to hold an MD.

But hey, no problem that we’re missing the cancer docs! Under our new Glorious People’s Care, the doctors will be quitting left and right – nobody will live long enough to need to worry about piddly things like cancer.

Blacksmith on November 17, 2009 at 2:21 PM

There is something fishy going on here with this report. I don’t trust anything coming from this administration, especially something that puts the spotlight on reducing or removing state mandates on insurance. We all know, or we should know, that Republicans have been battling to remove insurance coverage mandates – TO LOWER PREMIUMS. I have a good feeling that this will be twisted by the liberal media to put the spotlight on certain (Chris Christie) political figures who have in the past indicated that removing certain mandates would lower premiums…making affordable coverage available to more people.

Something is fishy here.

Fishy.Gov on November 17, 2009 at 2:21 PM

My aunt is Dr. Cynara Coomer, an oncologist who regularly appears on Fox News to discuss medical issues. She is whole heartily against these new guidelines and spoke about them this morning with Megyn Kelly. I haven’t check to see if the clip is online yet, but I’m sure it’ll be on FoxNews.com soon enough.

I think this is the government attempting to reset the expectations women have regarding their health check ups. It’s absolutely disgraceful and needs to be called out for what it is.

joshleguern on November 17, 2009 at 12:37 PM

I saw her on Fox News just this morning, talking about this very subject. And no, she was hot happy with this recommendation.

tom on November 17, 2009 at 2:22 PM

misterpeasea:

You gonna piss on our heads and call it rain?

Try and be an adult. My wife is in her 40’s and in excellent health with no history of breast cancer and is in a very low risk group. She is also very intelligent, and has read the literature (not the media) on the issue. She realizes that mammographies cause cancer. There are people out there who got breast cancer because they got a mammography. Considerating her personal factors, she will not get a mammography until she is in her 50’s. Nobody is pissing on her head, she is simply using her mind.

dave742 on November 17, 2009 at 1:07 PM

It’s an old expression meaning, “Don’t give me that BS.” And that seems appropriate, because the claim that mammograms cause cancer is BS. That’s a myth that causes lots of women to forgo screening that could save their lives.

tom on November 17, 2009 at 2:28 PM

Jeanie:

“Insurance companies and the government are not welcome parties to the choice and should not/never be.”

The reality right now is that insurance companies are a party to your choices. Why do you assume that the government choices would be worse than those of the insurance companies?
In government run systems, there is a huge savings overall because they don’t have to pay insurance companies to make their profits and to make their executives rich. All that money could be used for your health care instead. Why do prefer to give a significant portion of your health care dollars to insurance companies?

If your ideal situation is to have you and your doctor determine what your choices are, does that mean if my doctor and I decide that I should have a presidential physical every year, along with a personal doctor at my side 24/7, that you will agree to pay for it with your taxes? If not, does that mean you would want some time of regulation to be put on what a doctor and the patient can do with your health care dollars?

dave742 on November 17, 2009 at 2:30 PM

I am 45 because of a mammogram

Detection caught the problem..The insurance company never blinked..I got the necessary treatment and it was paid for under a policy that my husband got through work!

Pam on November 17, 2009 at 2:35 PM

dave742 on November 17, 2009 at 2:30

axlerod is that you? I’m on my iPhone and unable to adequately deconstruct that idiotic post.

Bah!

daesleeper on November 17, 2009 at 2:36 PM

The guidelines are for women who are not at high risk of breast cancer. How do they know if a woman is at high risk of breast cancer? My Mother-in-law and her four sisters lived well in their 80′s cancer free. My sister-in-law had breast cancer in her 30′s and died in her 50′s. By the time she died it had spread to her back and brain, two of the most painful cancers.

jeannie on November 17, 2009 at 2:38 PM

dave742 on November 17, 2009 at 1:07 PM

Umm..How does she actually know there is no history of b.c. in the family…Until our generation, medical histories were/are sketchy at best..I too thought there was no history in my family..until the mammogram..I still don’t know who had it before me, but I do know that I am a documented person in our families medical history.

Pam on November 17, 2009 at 2:39 PM

I’m 50 and just had my yearly mamo done and waiting on report this week. I have been called back for a diagnostic the last few years and had a ultra-sound year before last. As much as I dread these every year, I would really dread missing one and THEN finding something. Keeping my fingers crossed right now!!

DanaSmiles on November 17, 2009 at 2:40 PM

Cindy Munford: Not suggesting that they should not deal with anything they might find–in fact, they should. My argument is that it cannot be a substitute for mammography because many women have fatty cysts and simialr that certainly feel suspicious. Were these denied screening because of age, the worry and fear level would be out of control

jeanie on November 17, 2009 at 2:42 PM

dave742 on November 17, 2009 at 2:30 PM

Good Lord!!!!! Have you ever heard of Medicaid or Medicare? At least if you disagree with an insurance company you can sue, try that with the government. Are you aware that Medicare denies more procedures then private insurance?

Cindy Munford on November 17, 2009 at 2:43 PM

tom

the claim that mammograms cause cancer is BS

There are an awful lot of papers out there on this issue in the literature. You should E-mail them and tell them that it is a myth and that they are wasting their time.

The risk of getting breast cancer from a mammogram is exceedingly small. Of course. The risk of a healthy women in her 40′s with no history of breast cancer and not in any high risk group of getting breast cancer is also exceedingly small. You need to determine which is smaller.

On this website, they ask:

Should women be concerned about the radiation they receive when having periodic mammography x-rays or other procedures involving chest irradiation?

The answers is:

As stated earlier, cancer risk is related to age at the time of radiation exposure and the dose of radiation received. A mammography x-ray might result in a breast tissue dose of about 0.3 cGy. If a woman received 10 mammograms as a young woman, the total dose would be about 3 cGy. What is the risk associated with such exposure? Keeping in mind that epidemiologic studies have not detected statistically significant increases below a dose of about 20 cGy, we do know that 100 cGy increases risk by about 40%. One can estimate that the 3 cGy from periodic mammography screenings would increase your risk by about 1.2% or a relative risk of 1.012. Such low risks are not detectable in human studies. Nonetheless, all unnecessary radiation should be avoided and although the presumed risk is very small, it should be clear that the benefit from the medical exposure would far outweigh it. Decisions to have diagnostic procedures because of medical symptoms, however, should not be delayed because of the concern over presumed radiation risk.

What this means is that the risk is exceedingly small, but not zero. The web page also says:

Finally, women’s age at the time of exposure is also very important.

Getting 5 or 10 mammograms in your fourties has a non-zero risk of causing a cancer 30 or 40 years down the road. Another question is:

Is it true that while ionizing radiation can definitely cause breast cancer, it is not a major source of breast cancer cases?

The answer:

Yes. It has been estimated that less than one percent of all breast cancer cases might be attributed to ionizing radiation. Since most of this radiation comes from natural sources, which we have little control over, and from medical sources, which are for our benefit, there are few opportunities to reduce exposure and thus reduce risk. It should be noted though, that a few groups of women are at high risk of radiation-induced breast cancer for whom surveillance for early detection should be considered.

Less than 1 percent is not zero. There is a reason that the radiation tech that gives you a mammogram stands behind a shield.

dave742 on November 17, 2009 at 2:48 PM

jeanie on November 17, 2009 at 2:42 PM

Great, I agree with you then. It was so long ago that when I found mine (indeed fatty cysts) they didn’t have mammograms or needle biopsies. You are correct that some, maybe most, are too deep to be felt. I guess it’s a good idea for us to get our motors running about this report but thank goodness at this point it has no impact on what insurance companies will pay for. It pays to be vigilant.

Cindy Munford on November 17, 2009 at 2:48 PM

The reality right now is that insurance companies are a party to your choices. Why do you assume that the government choices would be worse than those of the insurance companies?

I pay a private company to insure my health. There are many private companies. There is one Federal Government. And as far as I know, my insurance company doesn’t have a police force and immunity from lawsuit. Private companies have to comply with consumer protection laws, unlike the biggest monopoly in the world, the Federal Government. They also have to be nimble enough to be profitable in a albeit restrictive competitive market. Governmental agencies have to protect their budgets and pay raises for administrators. They have to be able to spend money…they do not have to concern themselves with earning it.

And eventually, in order to enforce “fairness”, I won’t even be able to pay cash for tests that are refused by the unelected medical board…it will be illegal. That was the centerpiece of the bill in 1994 and undoubtedly the endgame in the current plan.

If lower costs and better care were the goals of this government in its health care plans, we’d be talking about medical savings accounts and opening up competition among all providers regardless of state lines. We’d be discussing how to protect those who cannot get health insurance instead of forcing everyone in America into the same box. This is about power and the loss of individual freedom.

If the current system isn’t too your liking, doubling down on the horrible and unfair parts of it seems like a poor solution.

Asher on November 17, 2009 at 2:51 PM

Cindy Mumford:

Are you aware that Medicare denies more procedures then private insurance?

First of all, show me.

Second, are you aware that people with Medicare are overall in a different age group than those with private insurance? Do you think that this might affect a comparison between the two?

dave742 on November 17, 2009 at 2:52 PM

Cindy Mumford:

At least if you disagree with an insurance company you can sue

That’s exactly what someone loaded down with medicals bills is prepared to do – pay a lawyer tens of thousands to take on an insurance company. Funny.

dave742 on November 17, 2009 at 2:54 PM

Medicare denies quite a bit. It is especially guilty of turning down prescribed drugs or insisting on generics even when the Doctor specifically requests the name drug for sound health reasons. Money saving? For many that’s the bottom line(forgive bad pun), but considering the amount of money this government wastes yearly on pork and pet projects,it’s member’s personal vanities and loses to fraud(which it cheerfully ignores),finances the well being of illegal aliens and spends on nonsense in general et al–if we’re going to be taxed to death at least let it be for a good reason.

jeanie on November 17, 2009 at 2:55 PM

Less than 1 percent is not zero. There is a reason that the radiation tech that gives you a mammogram stands behind a shield.

dave742 on November 17, 2009 at 2:48 PM

There’s a risk of getting killed every time you drive a car. But telling people that they should never drive because of that risk makes no sense. And skipping a screening test that has saved probably millions of lives because of a minuscule risk is bad advice.

So yes, I’ll stick to calling it a myth. Not because there’s no risk at all, but because the risk is so slight that it’s foolhardy to skip mammograms because of it.

tom on November 17, 2009 at 2:56 PM

Cindy Mumford:

At least if you disagree with an insurance company you can sue

That’s exactly what someone loaded down with medicals bills is prepared to do – pay a lawyer tens of thousands to take on an insurance company. Funny.
dave742 on November 17, 2009 at 2:54 PM

What Choice do you have with the Government?

A system with the efficiency of the DMV and the compassion of the IRS.

Juno77 on November 17, 2009 at 2:59 PM

The levels of radiation in the latest mammogram technology are minimal–or so I have read and been told.

jeanie on November 17, 2009 at 3:01 PM

dave742 on November 17, 2009 at 2:52 PM

http://www.ama-assn.org/ama1/pub/upload/mm/368/reportcard.pdf

Cindy Munford on November 17, 2009 at 3:05 PM

dave 42:

This is the crux of your argument:

If your ideal situation is to have you and your doctor determine what your choices are, does that mean if my doctor and I decide that I should have a presidential physical every year, along with a personal doctor at my side 24/7, that you will agree to pay for it with your taxes?

First of all, this is precisely why the majority of Americans do not want socialized healthcare. We don’t want the government bureaucracy or co- taxpayers to have a say in our individual healthcare decisions which is precisely what Obamacare mandates. Second of all, for every person who wants to pursue healthcare to the nth degree, there are others who do not. You central planners only look at past patterns of consumption without looking at the variances in consumption (and lack of consumption) amongst individuals which would show that some people are like your wife, who read up on the info and decide certain medical care is not needed or wanted, others simply neglect their health, others pursue alternative healthcare and some may just be lucky and make it through life without needing major medical care. The point is central planners do not have their thumb on all the cost variables within healthcare and the attempt to control an industry as large and complex as healthcare results in “whack-a-mole” regulation that stifles the delivery of healthcare creating inefficiencies and price distortions–precisely what we are experiencing now as a result of Medicare/Medicaid.

polmom on November 17, 2009 at 3:07 PM

Less than 1 percent is not zero. There is a reason that the radiation tech that gives you a mammogram stands behind a shield.

dave742 on November 17, 2009 at 2:48 PM

When you get radiation treatment for cancer they don’t even stay in the same room with you but it beats the hell out of death.

Cindy Munford on November 17, 2009 at 3:08 PM

I certainly hope this doesn’t mean my insurance company will use this as an excuse to stop covering my annual screenings.

I don’t pay $700/month to my hear my doctor say, “you’ve had a lump growing for the past 18 months”.

The Ugly American on November 17, 2009 at 3:08 PM

Cindy: I have read that the number of women with fatty cysts is very common. I have also read that these cysts often form in the thirties or after having nursed children. As you know, most of these are apparently harmless but this sounds like a very good reason to screen women in their thirties–at least to me it does. How on earth is one to know the difference without screening? Or, worse still, what if these do turn into something worse over time? You are right, this idea of denying screening has to be stopped in it’s tracks.

jeanie on November 17, 2009 at 3:11 PM

jeanie:
You are defending the age of 40 being the magical age when getting a mammogram should be supported. Why is this the magical age? Some people get breast cancer in their 20′s. Why shouldn’t the age be 20? There are two possible reasons for this. One is that there is a non-zero chance of getting breast cancer from a mammogram, especially at a young age. But people here say that ionizing radiation causing cancer is “BS”. There is only one other reason. Rationing. Why are you willing to ration mammograms? Why will you not allow people under 40 to get mammograms? Why shouldn’t 20 year olds get mammograms?

The real fact is, whether it is due to rationing or due to risks, there is a “optimum age” when it “makes sense” to start getting mammograms. In this article the U.S Preventive Services Task Force has decided that this “optimium age” is higher than what they thought. If people here disagree, they should say why beyond some off-the-cuff inane comment about death panels. Addressing the issues involved is probably a better approach.

dave742 on November 17, 2009 at 3:14 PM

I certainly hope this doesn’t mean my insurance company will use this as an excuse to stop covering my annual screenings.

I don’t pay $700/month to my hear my doctor say, “you’ve had a lump growing for the past 18 months”.

The Ugly American on November 17, 2009 at 3:08 PM

That is precisely what will happen. Private insurers already follow lockstep with government rules. This is why the AHIP has been on board with Obamacare. They are licking their chops at the prospect of “comparative effectiveness” studies that will let them off the hook for “ineffective” (read –expensive) healthcare. Both government and insurance companies will benefit at the expense of patients and doctors.

polmom on November 17, 2009 at 3:18 PM

Lib doctors are MORE dangerous individually than lib legislators. Imagine Pelosi with sharp objects and one-on-one life and death decisions. Not good.

marklmail on November 17, 2009 at 3:19 PM

The Ugly American on November 17, 2009 at 3:08 PM

So far these are just “guidelines”. American Cancer Society is screaming. We just need to keep our eyes open. The timing is interesting though.

Cindy Munford on November 17, 2009 at 3:20 PM

The worry about the cost of mammography is a red herring of the first order. Yes it costs. Yes, it is money well spent. Yes, I think women in their 30′s should get screening if they want it. Certainly women in their 40′s should if they feel uncomfortable without it.. As for women over fifty, well they are not at issue it seems–lucky them. Making a hard and fast rule based solely on age and percentages and cost is flat out wrong!!! That’s my story and I’m sticking to it.

jeanie on November 17, 2009 at 3:27 PM

I’ve heard liberals this morning, in justifying this, say,
“Younger women can still get mammograms, they just have to pay for it themselves.”

Substitute ‘abortion’ for ‘mammograms’ in this statement, libs, and then explain your objections to the Stupak ammendment.

mrt721 on November 17, 2009 at 3:33 PM

mrt721 on November 17, 2009 at 3:33 PM

Excellent point, hopefully someone will point that out.

Cindy Munford on November 17, 2009 at 3:38 PM

For what it is worth. The largest (by far) study on mammograms performed in europe and including over 35,000 women showed that routine mammograms did not decrease the overall mortality rates among women that were eventually diagnosed with breast cancer.

Redglen on November 17, 2009 at 3:43 PM

jeanie:
You did not mention women in their 20′s. Is your age 30? Why not women in their 20′s? Are you ready to pay for mammograms for tens of millions of women in their 20′s and 30′s, along with follow up procedures that are required for every false positive? Do you know what that cost might be?

Cindy Munford :
You supplied a link, but I don’t get it. The rate of denials for Medicare is equivalent to the rate for Aetna. For Medicare, 20.9% of their denials are for the procedure not being a medical necessity, and 8.5% of their denials are for procedures that are “not covered.” For Aetna, 7.7% of their denials are for procedures that are not covered because they are “experimental,” and 4.2% were for procedures that were “not covered.” Considering the fact that Medicare is covering very old people, I am not seeing the big difference.

dave742 on November 17, 2009 at 3:44 PM

When you get radiation treatment for cancer they don’t even stay in the same room with you but it beats the hell out of death.

Cindy Munford on November 17, 2009 at 3:08 PM

I had surgery and ID therapy this past Spring for Thyroid cancer and I was so traumatized, I didn’t even notice!!

DanaSmiles on November 17, 2009 at 3:46 PM

Cindy Mumford:
Medicare denies 6.85% of claims, which is not bad compared to California insurance companies, who deny 21%.

dave742 on November 17, 2009 at 3:46 PM

That should be RI therapy.

DanaSmiles on November 17, 2009 at 3:47 PM

Cindy Mumford:

At least if you disagree with an insurance company you can sue

That’s exactly what someone loaded down with medicals bills is prepared to do – pay a lawyer tens of thousands to take on an insurance company. Funny.
dave742 on November 17, 2009 at 2:54 PM

What Choice do you have with the Government?

A system with all the efficiency of the DMV and the compassion of the IRS.

Juno77 on November 17, 2009 at 3:53 PM

dave742 on November 17, 2009 at 3:44 PM

The point is that now I have the choice to pick the insurance company with the best rates and the best customer service. People have been paying for Medicare their entire lives and have no option once they hit age 62. The best they can do, if they can afford it, is to buy gap insurance to pay the difference in what Medicare pays and the true costs. Add to this that Medicare is going bankrupt and riddled with corruption, I have a hard time believing that you still think this is the preferred choice. The government doesn’t care, it’s not their money. It’s mine!!!

Cindy Munford on November 17, 2009 at 3:54 PM

I don’t understand the whole “tell women not to even do self-exams.” What harm does that do? Oh, wait, then women who do find lumps before the age of 50 might actually have to have their cancer treated before it’s “too late” and it’ll cost more than just having to provide “end of life” counseling.

I have a friend who, at age 41, did a self-exam, found a lump, got a mammogram, and yes it was cancer. She was treated and free of the disease in less than a year.

Under the new guidelines, she’d be DEAD long before she reached 50.

SouperConservative on November 17, 2009 at 3:55 PM

DanaSmiles on November 17, 2009 at 3:47 PM

I hope that everything went fine and your prognosis is outstanding!!! The strides they have made in treatment are astounding and we have a lot to be grateful for.

Cindy Munford on November 17, 2009 at 3:57 PM

SouperConservative on November 17, 2009 at 3:55 PM

Seriously! Maybe we are suppose to charging ourselves for the self exams and didn’t get the memo. Craziest suggestion in the whole story.

Cindy Munford on November 17, 2009 at 3:58 PM

Juno77 on November 17, 2009 at 3:53 PM

LOL! I guess if people have lived their entire lives getting services through the government, they don’t have a clue to the superiority of the private sector.

Cindy Munford on November 17, 2009 at 4:00 PM

For what it is worth. The largest (by far) study on mammograms performed in europe and including over 35,000 women showed that routine mammograms did not decrease the overall mortality rates among women that were eventually diagnosed with breast cancer.

Redglen on November 17, 2009 at 3:43 PM

But did the study include how many women found out too late and had to have more extensive treatment and mastectomies? I still think early detection could prevent the more invasive treatments.

maables on November 17, 2009 at 4:12 PM

Juno77 on November 17, 2009 at 3:53 PM

LOL! I guess if people have lived their entire lives getting services through the government, they don’t have a clue to the superiority of the private sector.
Cindy Munford on November 17, 2009 at 4:00 PM

So true, the problem is they want to impose that kind of existence on everyone else.

Juno77 on November 17, 2009 at 4:25 PM

The U.S Preventive Services Task Force recommendation before 2002 was for women over 50. In Feb of 2002, they changed the recommendation, saying that women 40 to 50 “probably would gain some benefit, too.”
Not a resounding statement. Even then they said the real benefit was for women 50 to 69. After the change, studies ccontinue to show no benefit.
Also, studies regarding self exames also show no benefit.

It’s funny, because if the U.S Preventive Services Task Force lowered the age from 40 to 35, there would be a thread on HA whining about how Obama and the liberals are raising our health insurance premiums.

dave742 on November 17, 2009 at 4:31 PM

this panel is also mostly ACADEMICS like Rahms brother…
utterly disgusting. I have a newsflash for peeps like Anne in CA, WOMENS healthcare is far more expensive, we will face much more rationing under Obamaisms….THIS is how they have always planned to bend the curve RATIONING, the preventative care shxt was just that BS, here they are CUTTING IT

this decision WILL result in CMS and most private insurers DENYING well woman mammogram screenings which are CURRENTLY COVERED, great way to expand coverage there Dems!

here (bottom of post)is an extremely important message from Susan G Komen Foundation please send it to every women you know:
We are concerned about a new study that may tempt women not to undergo their regular screening mammograms. The following is a longer version of a letter to the editor we’ve written after the study’s publication last week: “To raise new questions, new possibilities, to regard old problems from a new angle, requires creative imagination and marks real advance in science.”

Albert Einstein could have been talking about the debate that has churned from a Norwegian breast cancer study published in the Archives of Internal Medicine. It found women who had regular screening mammograms had 22 % more breast cancers diagnosed than women who only had one mammogram during a six-year period.

The study has raised the question whether certain breast tumors actually disappear without ever being treated. First, more studies will have to be conducted to replicate these results. Secondly, at this point in our understanding of the disease, we have no idea which tumors might be the ones most likely to regress.

We have a large body of scientific study showing the benefits of regular screening mammography. The screening tests have been shown to lower your risk of dying from breast cancer by 20 to 35 percent (depending on the study you’re looking at) if you’re 50 or older; and by up to 20 percent if you’re between 40 and 50.

The results of the Norwegian study does, I think, illustrate the need for more research in the area of breast tumors – specifically, about breast cancer in its early stages. We must remember that breast cancer is not just one disease. And obviously, studies like this latest one show just how much we don’t know about a cancer that kills a woman every 75 seconds worldwide.

It’s imperative to remind women that years of research and a multitude of studies have shown regular screening mammograms are the best line of defense in catching breast cancer early. And detecting this cancer, as is the case with many other types, as early as possible is critical to improving your odds of living.

The Norwegian study should not be ignored. To be sure, it raises intriguing, even somewhat troubling questions about breast tumors and how best to spot and treat them.

But to radically shift away from screening mammography as a course of action that repeatedly has been proven to save lives on the weight of a single study would do science …and us…a grave disservice.

Diana Rowden
Vice President

ginaswo on November 17, 2009 at 4:55 PM

The adjustment in recommendations was made in the face of reassessment of the latest clinical literature, not “where can we cut some corners?”. It’s a scientific argument and the cost of increased screening is not simply in dollars, but in morbidity and mortality due to follow-up testing (+/- surgery) which often proves to be unnecessary. Let’s stick with the real problems.

starflyer on November 17, 2009 at 5:00 PM

They are almost all professors.

Do you want a group of professors deciding if you live or die?

pabarge on November 17, 2009 at 5:24 PM

starflyer on November 17, 2009 at 5:00 PM

As long as this isn’t mandatory I don’t care but why do you thing that the American Cancer Society isn’t buying into it. Surely they would be for what is best both financially and in morbibdity and mortality rates.

Cindy Munford on November 17, 2009 at 5:59 PM

There is a reason that the radiation tech that gives you a mammogram stands behind a shield.

dave742 on November 17, 2009 at 2:48 PM

They stand outside the room or behind a shield because they do DOZENS of these tests a day!! Not one a year!

You DO understand that……right?

GEEZIS!

Talon on November 17, 2009 at 6:12 PM

Reducing the number of mamograms would have the green equivalence of taking 400,000 vehicles off the highways annually.

Who needs death panels when we can have task forces?

Welcome to medicine by government committee!

duncantwn on November 17, 2009 at 6:13 PM

People on here do realize that all 50 states have a mandate that requires insurance companies to cover mammograms…right? There is nothing else to talk about here..unless of course we want to talk about the reality that it’s Republicans (chris christie) who are the ones spear heading the effort to strip certain state mandates…..

What are we going to say when removing certain preventative minded mandates gains republican support?

Fishy.Gov on November 17, 2009 at 6:48 PM

Ok it’s official, our government wants to either kill most of us or keep us sick, sad and dependent. Your typical Malthusian policies at work brought to you by a trustworthy caring “peoples’” government that would make Mao and Peter Singer proud.

25 to 30 year old Brainwashed Watermelons, who are fresh out from a life time of amoral community learning centers aka tree hugging green sex camps aka mandatory government funded schools and colleges, believe their #1 duty as a citizens of the world is dying for mother earth. Upon death they are promised, by their one true god, Oprah, and her prophet, Al Gore, a tent full of hemp clothing with pockets filled with biodegradable glow sticks, matching dual 40 gig iphones with Harpo and Google apps with total 4G coverage, staked on the lawn at the never-ending 5 staged multicultural Bonnaroo Festival in the sky. If they report their remaining carbon using/exhaling, meat eating parents, grandparents, and pets to the nearest camp Gaia “with the active smokestacks”, the apostle Jeremy Piven promised “natural” enhanced soft boobs, low testosterone, and never ending rivers of soy milk for all… and backstage passes for their girlfriends. “If it’s for Gaia with Cyanide, then the Prophet Gore says its not Suicide, but if Dear Leader Catches any death by Gun, Mr. Soros keeps your tent and forever you sleep under the Righteous Son” was the favorite song of all the graduating Watermelons while waiting in line for their hip GE RFID do it all implant and a return home with a 6 year old education on 40 carbon credits to last until Bonnaroo.

Before I begin I’d like to give a shout out to all the men because we are next. The government will start rationing rubber gloves, and a doctor’s pointer finger will be off limits until age 65. At this rate within 6 years time, I’ll be trading a years worth of carbon credits for 3 gold flakes at the affirmative action black-market “non-profit so my profit” lone UN global environmental watchdog group headed by Gorbachev to pay for the illegal pleasure of asking one of the newly retired 30 year old doctors in town if he minds if I bend over the dented stressed hood of his banned Ford F150 for the quick yearly oil check. Shortly thereafter the topic will change to me inquiring if he is using the whole fist while staring at his dusty empty gun rack while tasting my tears and thinking of the good ole day’s when the Intelligentsia said Marxism was dead. Gorbachav’s, “Burdens of Profit”, whose slogans of “Shut up… Ill take that because once a Red always a Red” and “Still Looking great in green since Earth Day I because Rainbows are for Suckers!” and “Thanks for the help Hollywood now give us your land and wealth but please keep your women… we have Eastern Europe”,

The most efficient job in which all governments have excelled over the course of history is killing people… especially their own.–Me

God I was bored today while waiting for major surgery next week… now I’m mad, bored, and immobile.

Watching_Cloward-Piven on November 17, 2009 at 6:51 PM

Talon on November 17, 2009 at 6:12 PM

Exactly. The exposure of the patient is itty bitty in comparison to the technician and the patients natural exposure. An X-Ray techs’ exposure is going to be on par with someone building nuclear bombs at Oak Ridge. The crews working at Hanford and K-25/27 D&D get exposed to less radiation.

People on average in the course of their life time get exposed to more naturally occuring ionizing radiation than man made sources.

There were undergrad students at Los Alamos responsible for sweeping up the Plutonium dust. The Majority of them died old men still urinating plutonium.

Holger on November 17, 2009 at 6:51 PM

But, what about the prostate exam? CAN I SKIP THE PROSTATE EXAM?

Cybergeezer on November 17, 2009 at 7:09 PM

Will this apply to the WH, congress, and senate health care packages?

Annie on November 17, 2009 at 7:10 PM

I find this to be one of the most disgustingly
political give comfort to our enemy tactics
I could ever have imagined. Who among us
doesn’t know a women who has battled this
disease. I know four, only three brave
survivors. THEY WERE ALL UNDER 40
WHEN THEY WERE DIAGNOSED!

nocontrol on November 17, 2009 at 7:23 PM

And now the government is advising me not to touch my ta tas to see what I find myself. Fine – I’ll give the assignment to my husband.

Rockygold on November 17, 2009 at 7:34 PM

Sorry 40 on the brain…they were under 50.

nocontrol on November 17, 2009 at 7:46 PM

No mammograms until 50…

mmmmm-mmmmm-mmmmmm

Obamacare is good…

mmmmm-mmmmm-mmmmm

Khun Joe on November 17, 2009 at 7:54 PM

And now the government is advising me not to touch my ta tas to see what I find myself. Fine – I’ll give the assignment to my husband.

Rockygold on November 17, 2009 at 7:34 PM

Hey, maybe I can hang out my shingle as a profesional mammogrammer! ;-}

Dark-Star on November 17, 2009 at 7:57 PM

U.S Preventive Services Task Force, which works within the Department of Health and Human Services

I don’t trust HHS; they are responsible for H1N1 vaccine shortages (oh, and Obama first tapped Tom Daschle for HHS Sec, who cheated on his taxes and wrote a gosh-awful book on death panels/controlling costs in healthcare), I also don’t like nor trust HHS Sec. Seiblus who was a huge fan of late-term abortion doc, Tiller. While the gov of Kansas, she vetoed numerous bills that would require specific medical reasons for late-term abortion.

TN Mom on November 17, 2009 at 8:19 PM

Talon:

“They stand outside the room or behind a shield because they do DOZENS of these tests a day!! Not one a year!

As I explained, the risk is small but nonzero for routine mammographies. If the risk of one xray was zero, the risk of a thousand would be zero. Ionizing radiation is a non-threshold carcinogen.

“There isn’t a single oncologist among them”

Yes, and this is how it should be. Doctors do not know anything about statistics and the studies that measure them. Academics do, because they are the ones doing the studies, writing the papers, and running the statistics. For example, 160 gynecologists were given some facts concerning mammograms and the chances of having cancer if you have a positive mammogram. From the study:

“Disconcertingly, the majority of them grossly overestimated the probability of cancer, answering ‘‘90%’’ or ‘‘81%.’’ Another troubling result was the high variability in physicians’ estimates, ranging between a 1% and 90% chance of cancer. The number of physicians who found the best answer, as documented in medical studies, was slightly less than chance (21%).”Gigerenzer, et al. “Psychological Science in the Public Interest,” Nov 2007, Vol. 8 Issue 2, p53-96.

The number who figured out the correct answer from the known data was less than chance. A monkey would have had a better chance of getting the correct answer than a doctor. Academics know statistics and studies. Doctors do not.

When the US Preventive Services Task Force changed the screening age from 50 to 40 in 2002, Tommy Thompson was the secretary of Health and Human Services. His wife had breast cancer, and he believes that a mammography saved her. The likely reason the USPSTF changed their recommendation is that Thompson brow-beat them into it. I doubt it was about science. Another explanation could be that the “mammogram business has become highly lucrative, and younger women are the best customers.”

Regarding cost. Mammograms for women in their forties costs over $100,000 per year of life saved. This is ridiculous. And yes, sometimes it is about the money. As a comparison, a program of prenatal care for pregnant women is estimated to cost $2,800 per year of life saved. As another comparison, tamoxifen for breast cancer costs 1.3 million per year of life saved. Let’s see: 1.3 million for pharmaceutical companies? OK! One hundred thousand for the companies that make mammography machines and for the doctors offices that run them? OK! I don’t think many rich people will benefit from prenatal care classes, so let’s not emphasize that.

dave742 on November 17, 2009 at 8:26 PM

Man, these Socialist control freaks haven’t wasted any time!

Dr. ZhivBlago on November 17, 2009 at 8:30 PM

Regarding cost. Mammograms for women in their forties costs over $100,000 per year of life saved. This is ridiculous. And yes, sometimes it is about the money. As a comparison, a program of prenatal care for pregnant women is estimated to cost $2,800 per year of life saved. As another comparison, tamoxifen for breast cancer costs 1.3 million per year of life saved. Let’s see: 1.3 million for pharmaceutical companies? OK! One hundred thousand for the companies that make mammography machines and for the doctors offices that run them? OK! I don’t think many rich people will benefit from prenatal care classes, so let’s not emphasize that.

dave742 on November 17, 2009 at 8:26 PM

Three of my favorite things.
1. Reducing the value of human life to a dollar amount.
2. Class warfare.
3. Demonizing profits.

Herr Marx is that you?

daesleeper on November 17, 2009 at 8:45 PM

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