Breast Panels

Great Debates
1

On Tuesday, the United States Preventive Services Task Force recommended that women should not start routine mammograms until 50, whereas previously it was 40. This is in direct contradiction to recommendations by the ACS, doctors, advocates, and many survivors. Even the Administration is coming out and saying we should ignore the recommendation.

I can’t find a cite now, but an NPR story this morning stated that this could cost the lives of up to 15% of women in their 40s who get breast cancer.

Now, this is a bit problematic for the recent health care reform bill passed in the House. That bill, which establishes an nationwide exchange for health insurance, would use task forces like this one to set the requirements of what needs to be covered by a policy in order to participate in the exchange. It seems to be confirmation of the nightmare scenarios that had been presented by the GOP. Ration health care and people will die who could otherwise have been saved. It also primarily affects a demographic segment that is largely Democratic.

Do you think this task force’s recommendation is going to affect the bill that the Senate passes? The senate is already having a hard time finding enough votes to support the reform with the public option. Is this study going to be the death knell for that?

2

And in real terms that amounts to what? We’re not talking about 15% of women here, we are talking about 15% of those who get breast cancer.

Given that there are <13, 000 cases of invasive breast cancer in that age class annually, you are talking about 2000 people a year that could die. And that’s a could, not a will. So how many dollars per life saved does this add up to? If we don’t have this information we’ve have nothing. If that works out at a cost of 300 million dollars per life saved, would you still support it?

Every health care system in the world already rations health care. It’s a fact of modern life. No system can afford to give every person every possible treatment and diagnostic procedure currently in existence.

“women in their 40s” are largely Democratic?

3

Here’s Kathleen Sebelius’s response, FWIW:

http://www.kansascity.com/news/nation/story/1579344.html

4

The problem with those complaining that mammograms starting at “50 and every second year” would kill women and is therefore a bad thing is that supporting tests at “40 and every year” is killing women who would have been saved if only we would test at “30 and every six months”. That is, the previous recommendation was not at some special point, it was also a decision based on cost and effectiveness. We have to choose some guideline and the data apparently shows that the “40 and yearly” is not effective.

Heck, all the recommendations are currently condemning men to die, since there is no plan for men to be tested for breast cancer. That policy is responsible for the men who die of breast cancer (which is not zero).

Note also that the new recommendation only addresses women who are at the baseline risk of breast cancer. Anyone who has a family history of breast cancer or other risk factors are encouraged to test earlier and more frequently.

The same sort of logic would put the speed limit at 35 mph everywhere. Think of all the lives we’d save if everyone drove that slowly! Anyone supporting faster speed limits is condemning people to death. :rolleyes:

5

Here’s the website for the US Preventative Services Task Force, where they present this report along with supporting documents:

The recommendations are not based on the cost of the test in terms of dollars. The Task Force is saying that the tests are not effective or necessary for most women. As they put it,

Instead, they recommend

I’m not qualified to judge the medicine but clearly this is not a financial determination. Furthermore, it should be noted that this is a scientific review, not a policy making body. Their recommendations do not have the force of law, so to speak. Therefore trying to tie this to the health care plan is incorrect.

That said, I’d still rather have this panel of doctors and scientists making determinations rather than a panel of insurance bureaucrats which is what we have now. There are risks and benefits to every medical procedure. It’s reasonable to question if the medical risks of regular testing outweigh the medical risks of reduced testing for the general populace.

6

There is more to it. When women are younger the density of the breast tissue keeps from giving reliable information. The result is a lot of scares and sometimes procedures that are invasive.False positives are common . The cost, the unnecessary procedures, and the scare are balanced off by the occasional cancer catch. For every woman who was found with breast cancer, there are a lot who had scares, bad diagnosis or invasive treatments they did not need. You decide for yourself if you want to get checked, but they are not recommending it.

7

But if the public option/universal healthcare becomes fact, wouldn’t the recommendations of this panel be used as guidance in deciding whether or not the government will pay/reimburse for the procedure?

8

Whether or not the recommendations are sensible, they’re extremely unpopular. I would be absolutely shocked if they are incorporated into the bill. I don’t see why that would happen.

Just for reference, here’s an IMHO thread discussing the merits (or lack thereof) of the panel recommendations.

9

I think the Task Force is probably right when they say that we should primarily run the mammograms on people with other considerations or risk factors. The problem is - we don’t know all the other risk factors and we don’t have other tests. Yet. Mammograms are the current front-line.

10

There were no oncologists or, for that matter, women on the panel which made this determination. For that reason alone I’m holding it as suspect. As is the Secretary of Health & Human Services who has said, flat out, ignore it.

11

Where did you hear that particular line of bullshit? I don’t know if any of them are oncologists, but

I count 16 members. Seven of them are women.

12

Why? Are you saying that if your oncologist recommends getting more frequent screening, the government should refuse to pay? On the basis of this report?

But the report doesn’t claim that the mammograms cost too much. They claim early and frequent mammograms don’t provide better outcomes. Meaning, this is a guideline to doctors for how to advise their patients. It is not a guideline for insurance companies on when to pay for procedures.

13

The insurance companies would use it in a second. Whether it would be a rejected by the government remains to be seen. If you have a family history, you may have a pretty good argument . It is not settled yet. These are guidelines .
It is weird ,I have no dog in this fight . But I have seen several long programs on it . Rose had the panel members on. and “Democracy Now” covered it. So I learned that much.

14

All I know is I was diagnosed with a routine mammogram at 40. I shudder to think what could have happened if I’d waited 10 years or until the tumor got so big as to be noticeable.

And I was not high risk. I don’t smoke, and there’s no breast cancer in my family. Some cells just decided to zig instead of zag.

15

shrug This goes right to the heart of the “Death Panel” accusations.

If my Oncologist says I need a screen/test, the government may (and I say “may”, I don’t mean to imply that it’s a sure thing) respond by using this report to decline to pay for it, meaning that the patient is forced to decide to pay for it themselves, or forego the exam.

This is how it will be spun by RWTR, anyway.

So, there is no chance for the Law of Unintended Consequences to occur?

16

Echoed in the thread title.

17

:smack:

We need a whoosh smiley. :smiley:

18

How is the government different than for-profit insurance companies? Why aren’t you worried about your for-profit insurance company denying your coverage?

19

Correct me if I’m wrong, but the exchange would set minimum requirements for coverage. If a particular plan wanted to cover mammograms starting at age 25, no deductibles, and limousine rides to your optometrist, why do you believe that the exchange would prohibit such a policy from being offered? (Aside from the issue about how much such a plan would cost, of course.)

20

Ignorance fought on the issue of gender. I’m still looking for confirmation that anyone involved in making this patronizing decision is actually a cancer or even breast imaging expert.