Give Us Our Mammograms, Forget the Cost

my friends ...

By: Ian Blokesworth | Wed, 11/25/2009 - 14:23

This is the sad state of information-rich America. Women were taught that they have the power to fight breast cancer. Apparently, 85% of breast cancers are either very slow growing or very fast growing. By the time a self-exam or mammogram find a legitimate malignant tumor, the damage has been done or there will be no damage done. Thus, the recommendations that these exams in early years have nearly no effect on the death rate. It's better to get this out in the open today so that a greater emphasis can be placed on more effective detection and treatment instead of a false sense of female empowerment.

Why is "this" anyone's "fault"?

By: wackyjer | Wed, 11/25/2009 - 10:13

Blame the bad presentation of a task force taken by surprise, and the exploitation of that opportunity by the opponents of Obama's healthcare bill.

First of all, I'm not sure what you mean by "bad presentation". Do you mean that the task force released its findings at an inconvenient time for the healthcare-reform debate? Or that its findings were not released in language simple enough for more to understand? It seems to me that the findings were what they were, and a scientific task force released technical findings. What's blameworthy?

But beyond that, how is it exploitative to point out that a central cost-saving measure of proposed healthcare-reform plans is that the same or similar task force will produce findings with real and significant consequences for what services will be covered for whom and how often? It also bears mentioning that such cost-saving measures can only work if the political class has the fortitude to act according to the evidence. Instead, Kathleen Sebelius's retreat seems nothing but misleading and cowardly when she says that (for now, at least) the task force does "not set federal policy and they don't determine what services are covered by the federal government"? If the task force doesn't set policy, and its findings will not be heeded if politically unpopular, can it be explained why the task force exists?

Rather than seeking to blame opponents of health care reform, maybe it would be better to acknowledge what this episode really suggests: Government panels will crunch numbers in the aggregate, and set policies that will affect individuals, and there is at least some evidence that politicians might run for cover and throw the nerds under the bus. Ideally, the decision to pursue a course of treatment would be for a doctor and patient to discuss privately, and people would be able to disregard conventional wisdom if they had the money and could find a willing doctor. People don't like it when insurance companies tell them a procedure won't be covered, or will only be covered when the insurer says so. Proponents of the health care reform plans now being considered need to do a better job reassuring all of us that it will be better if the government has that authority, and tell the HHS Secretary to seek medical assistance to find her backbone.

I also join the clamoring

By: JC | Wed, 11/25/2009 - 10:10

I also join the clamoring chorus of "confused" cries.

My paternal grandmother died of breast cancer in 1985. I went in for my first mammogram last year (at 35) only to be told the next day that they found a suspicious spot on my left breast, back near my chest wall, and I would need to come in for another mammogram and ultrasound. You can't really see the spot on the mammogram, but could on the ultrasound. The doctor recommended a needle core biopsy, put in a titanium marker, and sent my sample off for testing. All clear. My "treatment protocol" is to return every six months for a mammogram and an ultrasound - the first visit after the biopsy, the technician couldn't even find the "lump" on the ultrasound.

My conundrum is this: I work for GE. We are losing are awesome coverage and going towards a "only preventative visits are covered 100%, everything else you pay for out of pocket until you cross the $5000 deductible" model. I will not be able to afford to pay out of pocket for a mammogram and ultrasound two times a year. What do I do?

After speaking with my ob/gyn and doing a bit of research, I have elected to remain with the "every two year" mammogram coverage now offered by my new insurance. It's some scary shit - I certainly don't want to have the agonizing death my grandmother has - but a risk I have no choice but to take.

And the bill for my ten minute needle core biopsy? SIX THOUSAND DOLLARS

Good and Bad

By: phpeter | Wed, 11/25/2009 - 09:14

There has been "Pink" awareness, save the Ta Tas PR campaigns, even sports teams having pink bats and football apparel. There is so much PR and society as a whole (men and women) have been told for years that more awareness, screenings, self exams etc. Now, this report tells something completely different. I don't know if it is right or wrong, but it flies in the face of the marketing that has been taking place. You can't blame the public for being confused on this issue.

It's not about cost!!!!!!

By: kb | Tue, 11/24/2009 - 23:12

Emily hasn't bothered to read the recommendations -- it is not about cost! Mammograms are pretty cheap, really. These findings are *positive* in the way that they are trying to maximize the overall health of the patient, not just poking and cutting and drugging everything that looks suspicious. I'm not sure if anyone is able to discern how much physical and psychological damage is done by unnecessary biopsies -- that's why this kind of thing is so controversial.

Let's compare with mastectomies vs. lumpectomies. Women protested congress to get the less-invasive surgery that gave the same outcome. A victory for women. Now this panel wants to further reduce the invasiveness of breast cancer treatment and people are up in arms. Women should be *clamoring* for this! And, now that this opinion is out there, women can continue to make informed decisions among many healthcare options.

Blame the doctors

By: Dudleys Mom | Tue, 11/24/2009 - 20:37

The doctors are belittling women who don't want mammograms and biopsies, that's why. I personally was harangued by several surgeons, when I formerly had a very low cancer risk (now I've had a benign biopsy, so my risk for cancer has increased). You have to search far and wide for a surgeon who has a rational approach to breast cancer prevention. Before you agree to a biopsy, get a second radiologist to read the mammogram (you might be surprised), and ask your surgeon about scanning technologies that image blood supply to any possible breast tumors, which can dramatically improve the accuracy of suspicious findings on a mammogram (be prepared to pay out-of-pocket, but you might avoid a scarring, potentially permanently damaging procedure, that will definitely increase your risk of future cancer). Thank you for this reasonable analysis of the situation in the midst of fear-mongering oncologists and understandably frightened women who have been brainwashed for years into having painful, traumatizing scans and biopsies that probably won't help them.

It's even worse, actually.

By: daw | Tue, 11/24/2009 - 19:10

It's even worse, actually. The panel is saying that leaving the issue of costs aside, mammograms for women under 50 without a family history of breast cancer do more harm than good. They hurt more than they help. The fact that stopping these mammograms would slightly lower the cost of health insurance is just icing on the cake. So what does the collective freakout of last week mean? People aren't very good at knowing what's in their best interests, have little to no understanding of statistics, and have a hard time coming to terms with their own mortality. It's really frustrating.

Slightly more understandable than death panels

By: TooGoodToCheck | Tue, 11/24/2009 - 18:47

I can sort of see a couple reasons why the advice to delay mammograms is bothering people. One is that cancer is really scary, and we've been taught that the most appropriate response is to take an aggressive stance against it. Even when doing nothing is the most reasonable response, it still feels wrong. There's something in our subconscious that says that if cancer is a threat, then we should be proactively trying to seek it out and kill it.

I also suspect (although I haven't been able to verify it in a couple minutes of research) that unreasonable levels of support for more proactive screening might be the result of the historical emphasis on five year survival rates, which tend to inflate the apparent benefits of early detection.

Further signs of the epidemic

By: sierraseven | Tue, 11/24/2009 - 17:52

Further signs of the epidemic of ignorance of science - what it is, how it works, how it's documented, and how we can use it for better lives.

It's disappointing and frustrating to see how many women base their opinions not on the facts - the actual report - but on someone else's opinion of someone else's opinion that it's all part of a vast liberal conspiracy to "ration" medical care.

"Seventy-six percent of women said they believe that the panel based its conclusions on cost, even though the task force's report included only scientific studies". It's reached the point that on those rare occasions when I hear of someone expressing reluctance to form an opinion before reading the actual source material, I feel positively giddy

Mammograms carry a small, but still meaningful, risk. If they do not make a significant difference in the outcome, the risk is not worthwhile. The promotion of mammography is, and always has been, a scam based on health-care businesses' need to amortize the substantial debt they took on in purchasing mammography equipment. There have always been better imaging choices with lower risk and better sensitivity and reliability. But we as women allowed ourselves to be convinced that having our breasts compressed into abnormal shapes and soaked with radiation was the best practice.

I predict that twenty years from now we'll look back on the whole mammogram scam and wonder what the heck we could have been thinking.