I’m in my early 40s and have been getting mammos for a while. My mom was diagnosed with breast cancer at age 83 earlier this year, so I have to keep getting the mammos.
Oh crap! Very good point! My current policy doesn’t cover breast exams for me, but I can certainly pay for them myself. But if we have universal health care, it will be illegal for me to get a private exam!!!1111sixsixsix
I have no idea. Then again, they’re not diagnosing or treating anyone’s cancer, they’re making a cost benefit analysis. But quoting from the profile page:
I clipped two other profiles of members who deal with cancer in some way, but were not on the panel at the time the recommendations were made.
Of course I am worried.
There are two points I’d like to make:
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I may be wrong, but I assume that it is easier to challenge or appeal a private industry’s bad or unfair decision than it is to challenge bad Federal legislation, whether or not that decision or legislation is based on budgetary concerns or poor science.
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If I were the cynical type (and I somewhat am), than this very type of study (the breast cancer issue here in the OP) can be seen as an example of the government making policy decisions based on budget, and not the (health) interests of the patient.
There are undeniably women under 50 who have had breast cancer detected by these “unnecessary” tests, no? If their tests are no longer covered by private insurance (or government provided insurance), some of these women will have not had the tests done early enough. (Especially considering some study by government funded experts concluded and publicly announced you likely don’t need the tests that early anymore.)
What happened to the shift in focus on a more “preventitive” approach to health care?
In my view, I am pro-choice because I feel that the person(s) best able to judge the merits of a situation/solution is the patient (and people most directly impacted by the circumstances), and not a government beaurecrat hundreds (or thousands) of miles away, applying a cookie cutter policy that denies care/procedures, one who may very well have different (or even conflicting) priorities.
I share some of your concerns, mlees, but:
This is not legislation.
This is not a policy decision either. It’s a general recommendation by a panel that exists for the purpose of making these kinds of recommendations.
Nobody has made any decisions about anyone else’s care here.
I guess the really stupid question is, did anyone have a problem with this panel when it did recommend annual mammograms for women over 40?
Why is that crucial? I presume they used data based of increased survivability as a result of earlier routine mammograms vs. negative impacts of false positives and unnecessary testing and procedures.
Why are oncologists the only ones capable of weighing those factors? Certainly they have valuable input to offer but I don’t see how if there isn’t an oncologist on the panel that statistical analysis is invalidated.
Noted.
Policy decisions are made based on recommendations like this. Especially if they make it easier to meet some self imposed goal of cutting government expenses.
I am looking at it from the view point of pending Government provided and funded health care. The timing of this annoucement was slightly odd (or convenient, depending on your point of view). If there was no national debate going on at this time, to be honest, I would not have been kneejerking much, because it would be harder to concieve of an ulterior motive.
They did, for a whole swath of women. You don’t feel folks (both private and non) will act on this/these recommendations?
If not, then why have the panel at all? (I am aware that my argument undercuts me, as well. 
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If they relaxed standards, there might have been some grumping. If they tightened them, probably not.
As an aside, I am bemused by some of the folks around here, lately. With BushCo in office, every government pronuncment was hyper analyzed with a very critical eye. But now that there is a new dude in the Oval Office, all that healthy (IMO) scepticism of the government (the majority of which are the same folks holding down those jobs during the Bush years) vanishes.
But, thanks for your patience, here. I could be overreacting… but I fear not.
That’s true at times.
I fail to see how a universally unpopular recommendation is “convenient” for anyone arguing for health care reform. If you want to speculate about the motives of the panel, though, you need to show me when the review started, not just the end date. Health care has been an issue for years and this specific reform debate has been going on since the summer.
No, they did not. They made a recommendation based on an analysis. They did not prevent anyone from getting an examination or deny coverage to anyone.
They might, and I’m concerned about the possibility of reduced insurance coverage. And I’d regret it if anybody died of cancer that would have been caught by one of these routine screens. But that doesn’t invalidate the guidelines themselves.
Exactly, and that’s inconsistent and unworkable. Someone had to decide to recommend routine mammograms every year from 40 rather than twice a year from 30, for example. I never heard any argument against the existing guidelines. If you’re allowed to recommend more screenings and never less, that’s not going to work for obvious reasons. Like I posted in the other thread: this may be the first time a government panel has weighed in on this subject, but other studies have concluded that routine mammograms do not save lives on the balance. That was even a part of the presidential debates last year when the subject turned to health care: the U.S. spends more money on health care, partly because of high testing volumes, but it’s not connected with people living longer.
True. C’est la vie.
But of course, this recommendation was made, not because it will save money, but because there is no evidence that yearly screenings starting at age 40 lead to better health outcomes.
It’s not that the screenings cost too much money. It’s that they don’t do any good. For every woman who has their cancer detected early, there’s another one who has a false positive, or a negative outcome from treatment.
This has nothing to do with cost, and everything to do with whether early screenings actually work.
In my experience oncologists aren’t the best ones to make screening recommendations. They see cancer all day every day, and they see it at its worst, so they tend to advocate the most aggressive screening possible regardless of the data.
It’s really hard to explain to patients why you might not want to do a screening test. (Hell, I lecture on this topic, and I have a hard time explaining it to other physicians.) I have not reviewed the data leading to this recommendation, but for every cancer you detect in a 40-49 year old, you have to consider (among other things):
–How many needle biopsies and excisional biopsies are you doing because of false positive results? How many complications are arising from those procedures?
–How many women are falsely reassured by a false negative mammo (which is likely in a 40-year-old with dense breast tissue) who will ignore a sore breast or a palpable lump?
–In that one case that the mammo picked up, would it have been detectable by some other method? If the mammo did pick it up before it was apparent clinically, was it earlier enough that it made a difference in the outcome?
So it’s not as simple as “do a test, find a cancer, safe a life”. There are risks to weigh against the benefits, and even if those risks seem remote the benefits in this group are really, really small.
I’ll be looking over the data soon. But I know that the USPSTF doesn’t change recommendations like this without very good reason.
By convenient, I meant it might enable someone (not necessarily the panels, but whoever is signing their paychecks) who’s goals is to reduce expected government expenditure to “trim” the overall cost estimates to something more politically easy to swallow by the public.
This is absolutely true. However, the end date is still important in my view, independant of the start date. Let’s say I start a study in '06, and is expected to finish up this year. Depending on the goals of whoever finally receives my draft report, it’s possible that it may be bounced back with a sticky note asking for ways to cut costs that are “reasonable”. “Reasonable” is subjective, and in any case, such an adjustment on the final report would be made due to fiscal, not health, reasons.
Was the question this panel attempting to address “What is the best age to start breast exam?”? Was it “At what age is it best to start breast exams, considering limited funds and lab availability?”
Those are two slightly different questions, just like as with “How can we make our cars the most safe [to operate]?” is different from “How can we make our cars the most safe, and still be affordable (e.g. priced marketably)?”
I prefer the government allow the patients and doctors to have the most flexibilty in deciding for themselves just how much health care is prudent or required.
I am not denying that it is (and will) be possible for someone to pay out of pocket for increased coverage or treatment, if they so desire.
However, I ask, if this recommendation is not intended to help shape (either private insurance, or government) policy, than just what the heck is it for?
Let’s say that none of the current legislation in debate in Congress passes, and gets dropped.
Do you feel that this panels recommendations might still affect the Medicare/Medicaid programs the Feds run? If not, why not?
I don’t think it’s unreasonable to dig a little. I can see some folks in this thread speculating that private insurance might possibly use this as justification to not pay for the procedures, and I interpret those staements as disapproving ones.
If the feces is found to be approaching the rotating blades, politicians will be more than happy to transfer blame of unpopular (or dangerous, if it actually turned out to be) effects of policy to this recommendation paper, and its panel members, citing that, afterall, they themselves are not doctors, but the ones who are recommended that they do “xyz”.
It only raises the point… what was the underlying purpose of the guidlines? To increase the quality of health care, or to make the point that women were undertaking unnecessary tests?
I do not feel that the Federal government is immune to fiscal worries, and those can effect policy. When schools, law enforcement, infrastructure (roads, bridges, water mains), and what-not, are said to be mismanaged and/or underfunded, it’s only natural to worry that the same mismanagment may happen in UHC.
Yeah. I understand the catch-22. I really do. That’s why I trust studies (and government) more when it has nothing to gain (or lose) with the (potential) effect of the results, and I look somewhat more closely when they do.
Self serving “legal interpretations” made by the Bush administration [in regards to Gitmo or wiretapping] were another example where closer scurtiny by the public was understandable.
On retrospect, let me ask this:
I noted before at the critical eye with which the members of the SDMB community looked upon other Federal actions and statements before.
It seems to me that some of the folks here are willing to accept the statements of the OP study at face value.
Why?
If you mistrusted (to some small extent) your government before, why not question everything until the Feds have proven that they can be trusted more?
Is it felt that a panel of academics (such as the one who released this study) cannot be influenced by the government (bosses), internal politics, or pressures from various special interest groups?
(I admit I have zero evidence of corruption or whatever. 
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mlees -
I’m not a doctor or a statistician so I’m not really qualified to judge the medicine either way. So as far as that goes, I have exactly the same reason to trust their judgment when they say, ‘start at 50’ as I did when they said, ‘start at 40.’ They’re experts. And so far I haven’t read anyone challenging their conclusions on the merits of their science. So far, all the arguments I’ve seen have been slippery slope type arguments and anti-government scare tactics.
Secondly, this is not the first report I’ve read suggesting that mammograms for the general populace are unhelpful. So while the conclusions are contrary to current US practice, they’re not a complete outlier.
Third, while this is a governmental panel, it’s not a bunch of politicians or insurance agents. They aren’t elected and they don’t directly affect legislation or policy in anyway. The fact that the Task Force was assembled by the government is different than it being part of the government. Also, I’ve not seen anyone try to argue that the Task Force is unqualified from an academic standpoint, and they’re an academic body.
Forth, my distrust for the Bush administration in general, and Bush’s personal ‘reverse-midas’ talents in particular, was based on their proven, systemic, incompetence. I’m not anti-government in general. I think the US has shortchanged itself in the last 30 years by trying to limit the size & scope of what the government can do. I think America’s at its best when it thinks big and focuses on civic growth, not solely individual growth.