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Mammogram Debate


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The past few days since the U.S. Preventive Services Task Force announced their recommendations on mammography and breast exams. I've been concerned about what could be interpreted as a trade off vs. cost that panels such as this can/will be making (policy?) in the possible future of American health choices under the "reform" presently being rushed through congress. This hits me in two ways, since I am not an advocate of the current direction of healthcare "reform" in the U.S. Additionally, being the single male in a family pretty much dominated by women, most recently a younger sister, 7 years in remission from breast cancer, then of course my personal enjoyment in performing exams on my girlfriend. I really see this recommendation as a negative toward the health choices of women in general. Am I reading into this too much? Am I making an emotional decision versus a fact based one?

 

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Diane Rehm Today

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It's an interesting discussion with severe ramifications. I know several women in our age bracket (early 40's) dealing with breast cancer, and in the face of it it seems counterintuitive.

 

The NO mammograms recommendation before 50 makes no sense to me, though they do make a case that there is a statistically insignificant advantage to yearly vs. every other year. But the statement that early detection with mammograms "only reduces mortality by 15%" seems 1) dubious and 2) well, I'll take the 15% better odds for my wife.

 

I'll see if I can drag my wife into this discussion.

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My fear is that insurance companies are going to use this to refuse payment

for women that would potentially benefit from early detection.

 

If I told my wife she was statistically insignificant, I'd know what it feels like when a frypan hits my head.

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The past few days since the U.S. Preventive Services Task Force announced their recommendations on mammography and breast exams. I've been concerned about what could be interpreted as a trade off vs. cost that panels such as this can/will be making (policy?) in the possible future of American health choices under the "reform" presently being rushed through congress. This hits me in two ways, since I am not an advocate of the current direction of healthcare "reform" in the U.S. Additionally, being the single male in a family pretty much dominated by women, most recently a younger sister, 7 years in remission from breast cancer, then of course my personal enjoyment in performing exams on my girlfriend. I really see this recommendation as a negative toward the health choices of women in general. Am I reading into this too much? Am I making an emotional decision versus a fact based one?

 

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Diane Rehm Today

If I understand it correctly, the only change was to recommend that woman at 40 consult with their physician whether or not to have annual mammogrophy rather than schedule the procedure automatically.

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If I understand it correctly, the only change was to recommend that woman at 40 consult with their physician whether or not to have annual mammogrophy rather than schedule the procedure automatically.

 

Does that make it elective then? If so, my HC may tell women it's not covered.

I'd still pay but what about the women it discourages and they then get a bad case of boobie cancer

that could have been not so bad if detected early?

I like bewbs. Protect them!

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Guest One of Five

Bowgirl here, sitting at kmccabe's computer and can't be bothered to sign him out & sign me in.

 

This is Bullshit! One more strike against preventive medicine. I'm a huge advocate of prevention - go for annual physicals, PAP/Mam/Bone Density every 2 yr (after 40) but before then PAP annually. I'd far rather spend my lifetime in preventive appointments, than lose my life because someone decided that statistically there was no cost:benefit. (oh, and "Lies, damned lies, and Statistics" seems appropriate here)

 

I see so often that if there's no money to be made, then it's deemed unimportant. What's Profit-making, yet again, out weighs what's Right.

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I can't comment on the merits, but the value of a test, e.g., a mammogram, depends on the prevalence of the condition it is designed to detect in the target population. So, for instance, if we got mammograms on all women and girls past the age of puberty, the likelihood of an abnormality representing cancer would be very low and the test would be almost useless as a tool for deciding whom to do a biopsy on. On the other hand, if we restrict mammograms to women over, say, 50, the prior likelihood of cancer is much higher and the test tells us something much more specific. Whether you you like the guideline or not, it is based on data like these.

 

We are going to need clear criteria that optimize the usefulness and cost effectiveness of tests as we move into an age of constrained health care spending. Sound health care policy that delivers good outcomes at the population level will sometimes look uncaring to individuals.

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Having no history of breast cancer in my family, and having read several studies as to the pros and cons of mammograms for women under 50, personally, I would not undergo this test unless a lump had been detected.

 

I would imagine that mammograms for women between 40 and 49 would still be covered, but only for those who are in higher risk categories.

 

Mammograms themselves carry a risk, from both radiation exposure and also from false positives.

 

In Canada, women over 50 may self-refer for breast screening. Younger women (I have a friend who started getting mammograms at 40 due to family history) may start screening earlier upon a doctor's recommendation. Everything I've read suggests those are reasonable guildeline. And I've never known anyone who had a good reason for needing one under 50 to be denied one.

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I can't comment on the merits, but the value of a test, e.g., a mammogram, depends on the prevalence of the condition it is designed to detect in the target population. So, for instance, if we got mammograms on all women and girls past the age of puberty, the likelihood of an abnormality representing cancer would be very low and the test would be almost useless as a tool for deciding whom to do a biopsy on. On the other hand, if we restrict mammograms to women over, say, 50, the prior likelihood of cancer is much higher and the test tells us something much more specific. Whether you you like the guideline or not, it is based on data like these.

 

We are going to need clear criteria that optimize the usefulness and cost effectiveness of tests as we move into an age of constrained health care spending. Sound health care policy that delivers good outcomes at the population level will sometimes look uncaring to individuals.

 

Interesting. I guess it's just arguing over the correct age then. 50 just seems a little late. Maybe compromise at 45 and be done?

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If I understand it correctly, the only change was to recommend that woman at 40 consult with their physician whether or not to have annual mammogrophy rather than schedule the procedure automatically.

 

Does that make it elective then? If so, my HC may tell women it's not covered.

I'd still pay but what about the women it discourages and they then get a bad case of boobie cancer

that could have been not so bad if detected early?

I like bewbs. Protect them!

I don't know the answer to your question, but aren't all recommendations ultimately elective when it comes to choice?

 

That is why I am for like a single payer type, and/or health care system in Great Britain, France, German, Switzerland, Japan, and Taiwan.

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I can't comment on the merits, but the value of a test, e.g., a mammogram, depends on the prevalence of the condition it is designed to detect in the target population. So, for instance, if we got mammograms on all women and girls past the age of puberty, the likelihood of an abnormality representing cancer would be very low and the test would be almost useless as a tool for deciding whom to do a biopsy on. On the other hand, if we restrict mammograms to women over, say, 50, the prior likelihood of cancer is much higher and the test tells us something much more specific. Whether you you like the guideline or not, it is based on data like these.

 

We are going to need clear criteria that optimize the usefulness and cost effectiveness of tests as we move into an age of constrained health care spending. Sound health care policy that delivers good outcomes at the population level will sometimes look uncaring to individuals.

 

That sounds like something Spock said in one of those Star Trek movies. Sound healthcare policy to me is whatever the patient and the doctor agree upon, together.

 

Edit: Thanks for your opinion Bowgirl. I'm finding that your's is the norm, at least in my experience.

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I can't comment on the merits, but the value of a test, e.g., a mammogram, depends on the prevalence of the condition it is designed to detect in the target population. So, for instance, if we got mammograms on all women and girls past the age of puberty, the likelihood of an abnormality representing cancer would be very low and the test would be almost useless as a tool for deciding whom to do a biopsy on. On the other hand, if we restrict mammograms to women over, say, 50, the prior likelihood of cancer is much higher and the test tells us something much more specific. Whether you you like the guideline or not, it is based on data like these.

 

We are going to need clear criteria that optimize the usefulness and cost effectiveness of tests as we move into an age of constrained health care spending. Sound health care policy that delivers good outcomes at the population level will sometimes look uncaring to individuals.

 

Interesting. I guess it's just arguing over the correct age then. 50 just seems a little late. Maybe compromise at 45 and be done?

 

I personally know of alot of women that have died in their 30's of breast cancer.

 

While less than 7% of breast cancer is diagnosed in women under 40, those who get it at younger ages also tend to develop more aggressive forms of the disease, which is likely why those women succumbed to it.

(The survival rate for a woman under 45 getting breast cancer is actually lower than that of a woman over 65, despite the fact they have a far lesser chance of developing it in the first place)

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I personally know of alot of women that have died in their 30's of breast cancer.

cc0802s.01.fig17.gif

 

Young women often have more aggressive disease and, because of the principle I outlined above, true positive mammograms are often misinterpreted in young women because of the low base rate and the large relative number of false positives.

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Sound healthcare policy to me is whatever the patient and the doctor agree upon, together.

No. That's the definition of sound health care. Sound health care policy is what relieves the most suffering and improves the most lives with the available resources.

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Bowgirl, can I assume that you weren't satisfied with the level of preventative care you received in Canada then?

 

BDM are not indicated for women under 65 without evidence of considerable risk.

Pap smears are recommended every 2 years.

Mammograms are recommended every 2 years after 50 (unless there is a genetic disposition).

 

As a 30-something female, I don't feel not having the above in any way equates to a lack of "preventative care". I still see my physician annually, and we discuss any issues that arise. But BDM, annual Pap smears, and mammograms would be of little, if any benefit in my age demographic. That's a common sense approach to medicine, not a lack of preventative care. And considering a Canadian woman can expect to live a year longer than her US counterpart, I'd also suggest that approach is effective.

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BJ, get you wife to chime in, would be interesting.

 

I don't think I will invite her into a thread you have elected to participate in.

 

I'll be nice. Promise. I'm with you on this one.

I don't think so.

 

You are not a Mutual Fund. Past performance is an excellent indicator of future performance.

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I can't comment on the merits, but the value of a test, e.g., a mammogram, depends on the prevalence of the condition it is designed to detect in the target population. So, for instance, if we got mammograms on all women and girls past the age of puberty, the likelihood of an abnormality representing cancer would be very low and the test would be almost useless as a tool for deciding whom to do a biopsy on. On the other hand, if we restrict mammograms to women over, say, 50, the prior likelihood of cancer is much higher and the test tells us something much more specific. Whether you you like the guideline or not, it is based on data like these.

 

We are going to need clear criteria that optimize the usefulness and cost effectiveness of tests as we move into an age of constrained health care spending. Sound health care policy that delivers good outcomes at the population level will sometimes look uncaring to individuals.

 

Here is my problem with this:

 

The statement says

 

"This recommendation statement applies to women 40 years or older who are not at increased risk for breast cancer by virtue of a known underlying genetic mutation or a history of chest radiation."

 

However, their recommendations for breast cancer screenings don't include screening for BRCA1 or BRCA2. How can you eliminate the recommendation for mammograms for women 40-49 without adding screening to find those women who would benefit from a mammogram due to a genetic predisposition for cancer?

 

The logic seems flawed to me.

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It is estimated that about 1% of women carry the BRCA1 or BRCA2 gene for breast cancer9 and these genes are believed to be responsible for 3-8% of all breast cancers10.

 

Wabbitter, are you advocating that all women should be screened for a gene that only 1% of women carry?

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The statement says

 

"This recommendation statement applies to women 40 years or older who are not at increased risk for breast cancer by virtue of a known underlying genetic mutation or a history of chest radiation."

 

However, their recommendations for breast cancer screenings don't include screening for BRCA1 or BRCA2. How can you eliminate the recommendation for mammograms for women 40-49 without adding screening to find those women who would benefit from a mammogram due to a genetic predisposition for cancer?

 

The logic seems flawed to me.

I'm not an expert, but those are autosomal dominant alleles, so there will almost always be a clear family history. Without that there's no reason to test for them.

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I can't comment on the merits, but the value of a test, e.g., a mammogram, depends on the prevalence of the condition it is designed to detect in the target population. So, for instance, if we got mammograms on all women and girls past the age of puberty, the likelihood of an abnormality representing cancer would be very low and the test would be almost useless as a tool for deciding whom to do a biopsy on. On the other hand, if we restrict mammograms to women over, say, 50, the prior likelihood of cancer is much higher and the test tells us something much more specific. Whether you you like the guideline or not, it is based on data like these.

 

We are going to need clear criteria that optimize the usefulness and cost effectiveness of tests as we move into an age of constrained health care spending. Sound health care policy that delivers good outcomes at the population level will sometimes look uncaring to individuals.

 

Here is my problem with this:

 

The statement says

 

"This recommendation statement applies to women 40 years or older who are not at increased risk for breast cancer by virtue of a known underlying genetic mutation or a history of chest radiation."

 

However, their recommendations for breast cancer screenings don't include screening for BRCA1 or BRCA2. How can you eliminate the recommendation for mammograms for women 40-49 without adding screening to find those women who would benefit from a mammogram due to a genetic predisposition for cancer?

 

The logic seems flawed to me.

 

 

 

Actually, they do suggest that "women whose family history is associated with an increased risk for deleterious mutations in BRCA1 or BRCA2 genes be referred for genetic counseling and evaluation for BRCA testing."

 

 

 

Examples of family medical histories that increase a woman's risk for inheriting a BRCA1 or BCRA2 mutation:

  • Women of Ashkenazi Jewish descent with any first-degree* relative (or two second-degree relatives on the same side of the family) with breast or ovarian cancer
  • Women with two first-degree relatives with breast cancer, one of whom received the diagnosis at age 50 years or younger
  • Women with a combination of three or more first- or second-degree relatives with breast cancer, regardless of age at diagnosis
  • Women with a combination of both breast and ovarian cancer among first- and second-degree relatives
  • Women with a first-degree relative with bilateral breast cancer
  • Women with a combination of two or more first- or second-degree relatives w/ovarian cancer, regardless of age at diagnosis
  • Women with a family history of breast or ovarian cancer that includes a relative w/a known deleterious mutation in BRCA1 or BRCA2
  • Women with a history of breast cancer in a male relative.

*A first-degree relative is defined as a parent, sibling or child. A second-degree relative is a relative with whom one quarter of an individual's genes is shared (i.e., grandparent, grandchild, uncle, aunt, nephew, niece, half-sibling).

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I can't comment on the merits, but the value of a test, e.g., a mammogram, depends on the prevalence of the condition it is designed to detect in the target population. So, for instance, if we got mammograms on all women and girls past the age of puberty, the likelihood of an abnormality representing cancer would be very low and the test would be almost useless as a tool for deciding whom to do a biopsy on. On the other hand, if we restrict mammograms to women over, say, 50, the prior likelihood of cancer is much higher and the test tells us something much more specific. Whether you you like the guideline or not, it is based on data like these.

 

We are going to need clear criteria that optimize the usefulness and cost effectiveness of tests as we move into an age of constrained health care spending. Sound health care policy that delivers good outcomes at the population level will sometimes look uncaring to individuals.

 

Here is my problem with this:

 

The statement says

 

"This recommendation statement applies to women 40 years or older who are not at increased risk for breast cancer by virtue of a known underlying genetic mutation or a history of chest radiation."

 

However, their recommendations for breast cancer screenings don't include screening for BRCA1 or BRCA2. How can you eliminate the recommendation for mammograms for women 40-49 without adding screening to find those women who would benefit from a mammogram due to a genetic predisposition for cancer?

 

The logic seems flawed to me.

 

 

 

Actually, they do suggest that "women whose family history is associated with an increased risk for deleterious mutations in BRCA1 or BRCA2 genes be referred for genetic counseling and evaluation for BRCA testing."

 

 

 

Examples of family medical histories that increase a woman's risk for inheriting a BRCA1 or BCRA2 mutation:

  • Women of Ashkenazi Jewish descent with any first-degree* relative (or two second-degree relatives on the same side of the family) with breast or ovarian cancer
  • Women with two first-degree relatives with breast cancer, one of whom received the diagnosis at age 50 years or younger
  • Women with a combination of three or more first- or second-degree relatives with breast cancer, regardless of age at diagnosis
  • Women with a combination of both breast and ovarian cancer among first- and second-degree relatives
  • Women with a first-degree relative with bilateral breast cancer
  • Women with a combination of two or more first- or second-degree relatives w/ovarian cancer, regardless of age at diagnosis
  • Women with a family history of breast or ovarian cancer that includes a relative w/a known deleterious mutation in BRCA1 or BRCA2
  • Women with a history of breast cancer in a male relative.

*A first-degree relative is defined as a parent, sibling or child. A second-degree relative is a relative with whom one quarter of an individual's genes is shared (i.e., grandparent, grandchild, uncle, aunt, nephew, niece, half-sibling).

 

I don't understand why that 2005 recommendation was not included in the screening list that was just released. It seems that they did the public a real disservice there. Intellectually, I can understand the statistical argument for dropping the generic recommendation for mammograms at 40 as long as there is renewed emphasis on finding the people who would benefit from those mammograms (ie people with the genetic mutation) or other risk factors. Because of the way they released this list (leaving the genetic screening out) people aren't getting that part of the picture.

 

And emotionally, I'm pretty unimpressed by the recommendation because I have a close friend with zero risk factors who was diagnosed with a really aggressive from of breast cancer in her early 40s. It was found through a routine mammogram. You would have a hard time convincing me that mammograms under age 50 are useless.

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Intellectually, I can understand the statistical argument for dropping the generic recommendation for mammograms at 40 as long as there is renewed emphasis on finding the people who would benefit from those mammograms (ie people with the genetic mutation) or other risk factors.

That's essentially a research question, which I hope is under active study. Better breast imaging would also help to solve the problem.

 

And emotionally, I'm pretty unimpressed by the recommendation because I have a close friend with zero risk factors who was diagnosed with a really aggressive from of breast cancer in her early 40s. It was found through a routine mammogram. You would have a hard time convincing me that mammograms under age 50 are useless.

I know you understand the issue, but not everyone does. Of course screening mammograms pick up up some cancers in young women, just as colonoscopy at age 40 will pick up some malignant polyps. Testicular ultrasound, anyone?

 

Again, I'm not arguing the merits because I'm not qualified, but the principle is legitimate and I really don't see a "womens' rights" issue here.

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I can't comment on the merits, but the value of a test, e.g., a mammogram, depends on the prevalence of the condition it is designed to detect in the target population. So, for instance, if we got mammograms on all women and girls past the age of puberty, the likelihood of an abnormality representing cancer would be very low and the test would be almost useless as a tool for deciding whom to do a biopsy on. On the other hand, if we restrict mammograms to women over, say, 50, the prior likelihood of cancer is much higher and the test tells us something much more specific. Whether you you like the guideline or not, it is based on data like these.

 

We are going to need clear criteria that optimize the usefulness and cost effectiveness of tests as we move into an age of constrained health care spending. Sound health care policy that delivers good outcomes at the population level will sometimes look uncaring to individuals.

 

Here is my problem with this:

 

The statement says

 

"This recommendation statement applies to women 40 years or older who are not at increased risk for breast cancer by virtue of a known underlying genetic mutation or a history of chest radiation."

 

However, their recommendations for breast cancer screenings don't include screening for BRCA1 or BRCA2. How can you eliminate the recommendation for mammograms for women 40-49 without adding screening to find those women who would benefit from a mammogram due to a genetic predisposition for cancer?

 

The logic seems flawed to me.

 

 

 

Actually, they do suggest that "women whose family history is associated with an increased risk for deleterious mutations in BRCA1 or BRCA2 genes be referred for genetic counseling and evaluation for BRCA testing."

 

 

 

Examples of family medical histories that increase a woman's risk for inheriting a BRCA1 or BCRA2 mutation:

  • Women of Ashkenazi Jewish descent with any first-degree* relative (or two second-degree relatives on the same side of the family) with breast or ovarian cancer
  • Women with two first-degree relatives with breast cancer, one of whom received the diagnosis at age 50 years or younger
  • Women with a combination of three or more first- or second-degree relatives with breast cancer, regardless of age at diagnosis
  • Women with a combination of both breast and ovarian cancer among first- and second-degree relatives
  • Women with a first-degree relative with bilateral breast cancer
  • Women with a combination of two or more first- or second-degree relatives w/ovarian cancer, regardless of age at diagnosis
  • Women with a family history of breast or ovarian cancer that includes a relative w/a known deleterious mutation in BRCA1 or BRCA2
  • Women with a history of breast cancer in a male relative.

*A first-degree relative is defined as a parent, sibling or child. A second-degree relative is a relative with whom one quarter of an individual's genes is shared (i.e., grandparent, grandchild, uncle, aunt, nephew, niece, half-sibling).

 

I don't understand why that 2005 recommendation was not included in the screening list that was just released. It seems that they did the public a real disservice there. Intellectually, I can understand the statistical argument for dropping the generic recommendation for mammograms at 40 as long as there is renewed emphasis on finding the people who would benefit from those mammograms (ie people with the genetic mutation) or other risk factors. Because of the way they released this list (leaving the genetic screening out) people aren't getting that part of the picture.

 

And emotionally, I'm pretty unimpressed by the recommendation because I have a close friend with zero risk factors who was diagnosed with a really aggressive from of breast cancer in her early 40s. It was found through a routine mammogram. You would have a hard time convincing me that mammograms under age 50 are useless.

 

 

But doctors should be aware. No different than lawyers, or those dreaded bankers, you pay them for their expertise.

I've yet to see my family doctor and NOT be asked about family history of cancer. She asks me every year.

 

And for every friend like yours who happens to have had breast cancer detected under 40, there are those who get false positives, particularly young women given breast density.

 

The US has a false positive for mammograms of about 15%. That's lower for post menopausal women, and higher for premenopausal women. There are costs and personal implications for every false positive: well documented stress and anxiety, needless procedure, etc.

 

And then there are the false negatives, which are more common in younger women, again due to breast density.

 

So while I'm glad your friend's breast cancer was detected early, the vast majority of women without pre-disposing risk factors don't benefit from early screening, and in fact, can be harmed by it.

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So how's that public healthcare looking now. This is just the beginning of a long road to low quality healthcare with the decision made by "expert panels" instead of doctors.

 

Also from the Sydney Morning Herald http://www.smh.com.au/national/doctors-sick-of-failure-to-fix-ailing-hospitals-20091118-imjr.html

 

 

If anything, I think this will give the insurance companies more grounds to deny service.

 

I've never known anyone who was denied access to a mammogram in Canada.

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So how's that public healthcare looking now. This is just the beginning of a long road to low quality healthcare with the decision made by "expert panels" instead of doctors.

 

Also from the Sydney Morning Herald http://www.smh.com.au/national/doctors-sick-of-failure-to-fix-ailing-hospitals-20091118-imjr.html

It's a guideline not a medical decision. Government and private bodies have been issuing them for decades. Doctors need them because they support decision making, make it easier to get insurers to pay for things, and provide the best possible defense against allegations of negligence by establishing standards of care. Do you think your insurer would just spring for screening colonoscopy for everyone if there weren't guidelines recommending it?

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Government and healthcare don't mix.

 

On paper, and actuarily, we spend far more not detecting cancers that don't exist than we do treating late stage disease. But that sure as shit isn't the point.

 

The doctors are against this, and the health insurers are against this. A mammogram is a $106 test that certainly doesn't break the bank at the insurance company and doesnt make the Dr a whole lot of money (cause the exam takes more than 5 mins).

 

I'm trying to figure out exactly who these idiots are -- breast cancer is a devastating and widely spread disease. Do these people not have sisters or mothers.

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Government and healthcare don't mix.

 

On paper, and actuarily, we spend far more not detecting cancers that don't exist than we do treating late stage disease. But that sure as shit isn't the point.

 

The doctors are against this, and the health insurers are against this. A mammogram is a $106 test that certainly doesn't break the bank at the insurance company and doesnt make the Dr a whole lot of money (cause the exam takes more than 5 mins).

 

I'm trying to figure out exactly who these idiots are -- breast cancer is a devastating and widely spread disease. Do these people not have sisters or mothers.

 

I'd suggest you spend some time researching screening protocols in the rest of the world. I'd also suggest you research the efficacy of mammograms period, and the efficacy in them in women under 50 specifically.

 

I was surprised to discover that the US recommended mammograms for women under 50 in the first place, because other than in parts of Asia, where women tend to develop breast cancer in their 40's, there very few places that gave 40 year old women who had no knwn risk factors regular mammograms.

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If I understand it correctly, the only change was to recommend that woman at 40 consult with their physician whether or not to have annual mammography rather than schedule the procedure automatically.

 

Does that make it elective then? If so, my HC may tell women it's not covered.

I'd still pay but what about the women it discourages and they then get a bad case of boobie cancer

that could have been not so bad if detected early?

I like bewbs. Protect them!

I don't know the answer to your question, but aren't all recommendations ultimately elective when it comes to choice?

 

That is why I am for like a single payer type, and/or health care system in Great Britain, France, German, Switzerland, Japan, and Taiwan.

It appears that this Canadian study confirms the importance of consulting with a physician whether or not to have annual mammography.

 

"Having a usual source of care, recent contact with a physician, and receiving a recommendation from a physician have been found to be salient predictors of mammography use.23, 26, 27, 31 The strong association between mammography use and contact with doctors in this study supports the previous research and emphasizes the importance of the doctor’s role in promoting the use of mammography."

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Government and healthcare don't mix.

 

On paper, and actuarily, we spend far more not detecting cancers that don't exist than we do treating late stage disease. But that sure as shit isn't the point.

 

The doctors are against this, and the health insurers are against this. A mammogram is a $106 test that certainly doesn't break the bank at the insurance company and doesnt make the Dr a whole lot of money (cause the exam takes more than 5 mins).

 

I'm trying to figure out exactly who these idiots are -- breast cancer is a devastating and widely spread disease. Do these people not have sisters or mothers.

 

I'd suggest you spend some time researching screening protocols in the rest of the world. I'd also suggest you research the efficacy of mammograms period, and the efficacy in them in women under 50 specifically.

 

I was surprised to discover that the US recommended mammograms for women under 50 in the first place, because other than in parts of Asia, where women tend to develop breast cancer in their 40's, there was no where else that I could find that routinely gave 40 year old women who had no knwn risk factors regular mammograms.

 

Every female in my family -- on both my mothers and fathers sides -- have had breast cancer in their 40s. So don't play BULLSHIT STATISTICS with me. Healthcare isn't about macroeconomics. Its about people making educated decisions about staying alive. BREAST CANCER KILLS. One in 8 women get it. X percentage of that happens when people are in their 40s. The kinds that strike people in their 40s is typically nasty.

 

Don't be an asshole over a $100 test.

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Government and healthcare don't mix.

 

On paper, and actuarily, we spend far more not detecting cancers that don't exist than we do treating late stage disease. But that sure as shit isn't the point.

 

The doctors are against this, and the health insurers are against this. A mammogram is a $106 test that certainly doesn't break the bank at the insurance company and doesnt make the Dr a whole lot of money (cause the exam takes more than 5 mins).

 

I'm trying to figure out exactly who these idiots are -- breast cancer is a devastating and widely spread disease. Do these people not have sisters or mothers.

 

I'd suggest you spend some time researching screening protocols in the rest of the world. I'd also suggest you research the efficacy of mammograms period, and the efficacy in them in women under 50 specifically.

 

I was surprised to discover that the US recommended mammograms for women under 50 in the first place, because other than in parts of Asia, where women tend to develop breast cancer in their 40's, there was no where else that I could find that routinely gave 40 year old women who had no knwn risk factors regular mammograms.

 

Every female in my family -- on both my mothers and fathers sides -- have had breast cancer in their 40s. So don't play BULLSHIT STATISTICS with me. Healthcare isn't about macroeconomics. Its about people making educated decisions about staying alive. BREAST CANCER KILLS. One in 8 women get it. X percentage of that happens when people are in their 40s. The kinds that strike people in their 40s is typically nasty.

 

Don't be an asshole over a $100 test.

 

 

 

everything i've said is in complete agreement with what you just posted, so what's your problem?

 

If every female in your family had breast cancer at a young age, there is a reasonable chance that they carry the genetic markers for it. There is absolutely every good reason for every female in your family to have regular mammographies after 40 (unlike every female in my family). But just because that's good for every female in YOUR family, doesn't mean it's good advice for every female PERIOD.

Yes, breast cancer kills. But it is also one of the most treatable forms of cancer a woman can get. In Canada, there is an 87% 5 year relative survival rate. Those are pretty decent odds, as far as cancer goes.

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Government and healthcare don't mix.

 

On paper, and actuarily, we spend far more not detecting cancers that don't exist than we do treating late stage disease. But that sure as shit isn't the point.

 

The doctors are against this, and the health insurers are against this. A mammogram is a $106 test that certainly doesn't break the bank at the insurance company and doesnt make the Dr a whole lot of money (cause the exam takes more than 5 mins).

 

I'm trying to figure out exactly who these idiots are -- breast cancer is a devastating and widely spread disease. Do these people not have sisters or mothers.

I don't see how such a guideline stops any insurer from paying for mammograms at any age.

 

Here's a list of the "idiots". I have contributed my own idiocy to the same agency on a different subject.

 

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

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Government and healthcare don't mix.

 

On paper, and actuarily, we spend far more not detecting cancers that don't exist than we do treating late stage disease. But that sure as shit isn't the point.

 

The doctors are against this, and the health insurers are against this. A mammogram is a $106 test that certainly doesn't break the bank at the insurance company and doesnt make the Dr a whole lot of money (cause the exam takes more than 5 mins).

 

I'm trying to figure out exactly who these idiots are -- breast cancer is a devastating and widely spread disease. Do these people not have sisters or mothers.

 

I'd suggest you spend some time researching screening protocols in the rest of the world. I'd also suggest you research the efficacy of mammograms period, and the efficacy in them in women under 50 specifically.

 

I was surprised to discover that the US recommended mammograms for women under 50 in the first place, because other than in parts of Asia, where women tend to develop breast cancer in their 40's, there was no where else that I could find that routinely gave 40 year old women who had no knwn risk factors regular mammograms.

 

Every female in my family -- on both my mothers and fathers sides -- have had breast cancer in their 40s. So don't play BULLSHIT STATISTICS with me. Healthcare isn't about macroeconomics. Its about people making educated decisions about staying alive. BREAST CANCER KILLS. One in 8 women get it. X percentage of that happens when people are in their 40s. The kinds that strike people in their 40s is typically nasty.

 

Don't be an asshole over a $100 test.

 

 

 

everything i've said is in complete agreement with what you just posted, so what's your problem?

 

If every female in your family had breast cancer at a young age, there is a reasonable chance that they carry the genetic markers for it. There is absolutely every good reason for every female in your family to have regular mammographies after 40 (unlike every female in my family). But just because that's good for every female in YOUR family, doesn't mean it's good advice for every female PERIOD.

Yes, breast cancer kills. But it is also one of the most treatable forms of cancer a woman can get. In Canada, there is an 87% 5 year relative survival rate. Those are pretty decent odds, as far as cancer goes.

 

Have you shown your tits on SA yet? If not, this thread would be appropriate. Its for science.

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I don't see how such a guideline stops any insurer from paying for mammograms at any age.

 

Here's a list of the "idiots". I have contributed my own idiocy to the same agency on a different subject.

 

 

Rosanne Leipzig, M.D., Ph.D

Professor, Geriatrics and Adult Development, Medicine, Health Policy

Mount Sinai School of Medicine, New York, NY

 

Hmmm...I will see if my wife studied under this one during residency.

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Here's a very thoughtful analysis in lay language from a cancer surgeon. He doesn't like the guidelines, but recognizes their legitimacy. The point is that even elite guys at academic institutions recognize guidelines as the best way to codify best practices, based on empirical data, not some socialist plot.

 

The man is a fine writer.

 

The timing of this announcement coming as it does, right

after the recent special treatment of abortion payments of

women was in the news is most unfortunate. Women

may be starting to wonder wtf is going on here, all the sudden like.

 

"Facts can't be insolent"? Clearly, dealing with women

is not his long suit. Man's lucky he's a doc, I suspect...

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The man is a fine writer.

...and a bit of a conceited prick, but I do like the way he goes after bullshit like a pit bull on amphetamine and he gets a pass for being a surgeon.

 

Another point of view.

Good summary and she links to Orac for a "wonkier" point of view.

 

One thing I hadn't realized was that cost was not included as a factor in the model that led to the USPSTF findings.

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Interesting that the White House is stumbling over itself to deny the report from the USPSTF to be of significance in healthcare policy, now or in the future. I read, you were not supposed to see or hear anything like this till after 2014. Why have these panels, if their findings (opinions?) have nothing to do with government policy? Is this an example of the waste we hear about that healthcare reform will correct? (In case you didn't catch it, the last question was mocking the bullshit that is attempting to become Democare)

 

"Some speculated that the administration fears that opponents of health-care reform will use the issue to undermine support for an overhaul, in the same way that critics charged over the summer that reform would lead to "death panels" to decide whether lifesaving care would be given."- WP

 

The Washington Post

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A balanced and accurate commentary from Maggie Wente in today's Globe and Mail:

Does cancer screening do harm?

By Margaret Wente

From Thursday's Globe and Mail

Over-diagnosis has plenty of side effects - needless surgery and trauma, emotional anguish, wasted money and resources

Every woman knows the breast cancer catechism by heart. Early detection is crucial, and prevention measures are important. Regular mammograms are essential - probably the more the better. For years, we've been lectured on the importance of breast self-examination, and every gym had waterproof instructions posted in the showers. We knew the lifestyle advice: Eat your fruits and veggies, get lots of exercise, don't drink too much, don't get fat.

 

But now we're learning that much of this advice is about as useful as lucky charms to ward off the evil eye.

 

In the U.S., a leading advisory panel on breast cancer touched off a storm of controversy this week when it recommended against routine mammograms for women in their 40s. Experts filled the airwaves. Some endorsed the new guidelines, some did not, and some said women should consult their doctors. Others issued dire warnings: "Women are the first group to suffer when cost cutting takes precedent over sound medical care," said one female doctor.

 

The new U.S. guidelines look a lot like Canada's. They say screening isn't useful for women in their 40s and that, after 50, every other year is good enough. As for breast self-exams, they do no good at all.

 

For a generation of women who've learned to be super-vigilant about breast cancer, the news came as a shock. How can less screening be better? So here's a bigger shock: Screening can do more harm than good.

 

"A lot of [women] have not been fully informed about the over-diagnosis scenario," says Cornelia Baines, who led a landmark study of mammography in Canada. Mammography is not a very good tool. It detects many cancers that would be harmless if left untreated (and sometimes misses deadly ones). And a horde of people must be screened to avoid one death. If 2,000 women are screened regularly for 10 years, only one will avoid death from breast cancer. But 10 healthy women will undergo unnecessary treatment because of false positives.

 

We would like things to be more in our control.

 

Over-diagnosis has plenty of social and personal side effects - needless surgery and trauma, emotional anguish, wasted money and resources. Last month, The New York Times reported that the American Cancer Society is changing its message about screening for breast cancer. "The advantages to screening have been exaggerated," said Otis Brawley, the cancer society's chief medical officer. Its new message will emphasize the risks as well as the benefits.

 

The emphasis on early detection has made the problem worse. "With the advent of widespread efforts to diagnose cancer earlier, over-diagnosis has become an increasingly vexing problem," writes U.S. cancer expert Gilbert Welch. How big is the problem? One gold-plated research study, conducted by the Nordic Cochrane Centre group, says that as many as one in three women are treated unnecessarily. The problem, of course, is that we don't know which ones.

 

The over-diagnosis problem is well known in medical circles. But cancer agencies have been slow to acknowledge it, because it's hugely political. "If you question over-diagnosis in breast cancer, you are against women," cancer expert Peter Albertson told The New York Times. It is also political because large segments of the medical industry - including radiologists, surgeons, pathologists and medical-equipment vendors - stand to lose if screening is cut back.

 

The idea that screening carries risks undermines the main cancer narrative of our age - that it is under-detected, under-treated and invariably lethal. The prevention narrative is wrong, too. With the obvious exception of lung cancer, it turns out there's not much you can do to prevent cancer. Despite extensive research, no clear link has yet been found between breast cancer, diet and exercise.

 

So why do we want so hard to believe? "It's wishful thinking," says cancer expert Susan Love. "We would like things to be more in our control."

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Interesting that the White House is stumbling over itself to deny the report from the USPSTF to be of significance in healthcare policy, now or in the future. I read, you were not supposed to see or hear anything like this till after 2014. Why have these panels, if their findings (opinions?) have nothing to do with government policy? Is this an example of the waste we hear about that healthcare reform will correct? (In case you didn't catch it, the last question was mocking the bullshit that is attempting to become Democare)

 

"Some speculated that the administration fears that opponents of health-care reform will use the issue to undermine support for an overhaul, in the same way that critics charged over the summer that reform would lead to "death panels" to decide whether lifesaving care would be given."- WP

 

The Washington Post

You're right. It is disingenuous to claim that a finding like has nothing to do with policy, but it isn't policy until its recommendations are instituted by some authority. This is not the only advisory body out there and, CMS, for instance, has many qualified voices to listen to when they decide what they'll pay for.

 

We would all be much better off with more science and less politics in health care.

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Jfc, just how much do these tests costs? In like L.A. Dollars? $500? $300? $61.98? The price of three StarFux double lactosi?.............

 

I heard on the news that it's about $100. The guy in the interview on MSNBC broke it down using a quote from Dr. Otis Brawley from the American Cancer Society that I was able to find in an AP article --

 

The task force advice is based on its conclusion that screening 1,300 women in their 50s to save one life is worth it, but that screening 1,900 women in their 40s to save a life is not, Brawley wrote.

 

So doing the math, the panel has decided that a woman's life is worth somewhere between $130,000 and 190,000.

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Jfc, just how much do these tests costs? In like L.A. Dollars? $500? $300? $61.98? The price of three StarFux double lactosi?.............

 

I heard on the news that it's about $100. The guy in the interview on MSNBC broke it down using a quote from Dr. Otis Brawley from the American Cancer Society that I was able to find in an AP article --

 

The task force advice is based on its conclusion that screening 1,300 women in their 50s to save one life is worth it, but that screening 1,900 women in their 40s to save a life is not, Brawley wrote.

 

So doing the math, the panel has decided that a woman's life is worth somewhere between $130,000 and 190,000.

The panel explicitly ignored monetary costs, but if you wanted to consider the whole picture, you'd have to include the costs of biopsies, etc. for women with false positive findings.

 

I knew Otis Brawley when he was a fellow at the NCI. He's a very good guy and I'm sure he would concede that population screening may be justified at 40, but not at, say, 35, even though there's a non-zero rate of breast cancer at that age. Everyone with a plan for population screening has to set a threshold below which a certain number of deaths from late diagnosis will occur.

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A balanced and accurate commentary from Maggie Wente in today's Globe and Mail:
Does cancer screening do harm?

By Margaret Wente

From Thursday's Globe and Mail

Over-diagnosis has plenty of side effects - needless surgery and trauma, emotional anguish, wasted money and resources

Every woman knows the breast cancer catechism by heart. Early detection is crucial, and prevention measures are important. Regular mammograms are essential - probably the more the better. For years, we've been lectured on the importance of breast self-examination, and every gym had waterproof instructions posted in the showers. We knew the lifestyle advice: Eat your fruits and veggies, get lots of exercise, don't drink too much, don't get fat.

 

But now we're learning that much of this advice is about as useful as lucky charms to ward off the evil eye.

 

In the U.S., a leading advisory panel on breast cancer touched off a storm of controversy this week when it recommended against routine mammograms for women in their 40s. Experts filled the airwaves. Some endorsed the new guidelines, some did not, and some said women should consult their doctors. Others issued dire warnings: "Women are the first group to suffer when cost cutting takes precedent over sound medical care," said one female doctor.

 

The new U.S. guidelines look a lot like Canada's. They say screening isn't useful for women in their 40s and that, after 50, every other year is good enough. As for breast self-exams, they do no good at all.

 

For a generation of women who've learned to be super-vigilant about breast cancer, the news came as a shock. How can less screening be better? So here's a bigger shock: Screening can do more harm than good.

 

"A lot of [women] have not been fully informed about the over-diagnosis scenario," says Cornelia Baines, who led a landmark study of mammography in Canada. Mammography is not a very good tool. It detects many cancers that would be harmless if left untreated (and sometimes misses deadly ones). And a horde of people must be screened to avoid one death. If 2,000 women are screened regularly for 10 years, only one will avoid death from breast cancer. But 10 healthy women will undergo unnecessary treatment because of false positives.

 

We would like things to be more in our control.

 

Over-diagnosis has plenty of social and personal side effects - needless surgery and trauma, emotional anguish, wasted money and resources. Last month, The New York Times reported that the American Cancer Society is changing its message about screening for breast cancer. "The advantages to screening have been exaggerated," said Otis Brawley, the cancer society's chief medical officer. Its new message will emphasize the risks as well as the benefits.

 

The emphasis on early detection has made the problem worse. "With the advent of widespread efforts to diagnose cancer earlier, over-diagnosis has become an increasingly vexing problem," writes U.S. cancer expert Gilbert Welch. How big is the problem? One gold-plated research study, conducted by the Nordic Cochrane Centre group, says that as many as one in three women are treated unnecessarily. The problem, of course, is that we don't know which ones.

 

The over-diagnosis problem is well known in medical circles. But cancer agencies have been slow to acknowledge it, because it's hugely political. "If you question over-diagnosis in breast cancer, you are against women," cancer expert Peter Albertson told The New York Times. It is also political because large segments of the medical industry - including radiologists, surgeons, pathologists and medical-equipment vendors - stand to lose if screening is cut back.

 

The idea that screening carries risks undermines the main cancer narrative of our age - that it is under-detected, under-treated and invariably lethal. The prevention narrative is wrong, too. With the obvious exception of lung cancer, it turns out there's not much you can do to prevent cancer. Despite extensive research, no clear link has yet been found between breast cancer, diet and exercise.

 

So why do we want so hard to believe? "It's wishful thinking," says cancer expert Susan Love. "We would like things to be more in our control."

Yes and if you take that 2000 screened and convert it to 100,000,000 the number of woman between 40 and 50 in the US (over a ten year time frame) that would be 50,000 woman saved over ten years.

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Yes and if you take that 2000 screened and convert it to 100,000,000 the number of woman between 40 and 50 in the US (over a ten year time frame) that would be 50,000 woman saved over ten years.

 

and where did you read that that statistic applies only to women under 50?

Oh right, you didn't.

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Yes and if you take that 2000 screened and convert it to 100,000,000 the number of woman between 40 and 50 in the US (over a ten year time frame) that would be 50,000 woman saved over ten years.

 

and where did you read that that statistic applies only to women under 50?

Oh right, you didn't.

 

Thanks for pointing that out - You do understand that it would increase the number saved substantially.

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Yes and if you take that 2000 screened and convert it to 100,000,000 the number of woman between 40 and 50 in the US (over a ten year time frame) that would be 50,000 woman saved over ten years.

 

and where did you read that that statistic applies only to women under 50?

Oh right, you didn't.

 

Thanks for pointing that out - You do understand that it would increase the number saved substantially.

 

You do not understand that these guideline will actually have a far greater impact on the number of women who receive false positives (because there's many more of them, than there are women under 50 diagnosed and successfully treated for breast cancer) and undergo needless anxiety, psychological trauma and unneccessary medical procedures as a result.

 

I'm not sure where you all got this idea that mammography is perfect, particularly in pre-menopausal women, because it's actually far from it.

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What I find rather humourous, is that the same people saying that everyone should be screened, because one life saved would be worth it, are probably the same people who get all bent out of shape when the government tells them they have to wear helmets on bikes and motorcycles. :lol:

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You do not understand that these guideline will actually have a far greater impact on the number of women who receive false positives (because there's many more of them, than there are women under 50 diagnosed and successfully treated for breast cancer) and undergo needless anxiety, psychological trauma and unneccessary medical procedures as a result.

 

 

That's actually a two-edged sword, though.

 

Statistically, for every X number of false positives that you eliminate, you're going to have Y more women dying of breast cancer because it was not caught in time.

 

Eliminating false positives and overdiagnosis does not come without a cost.

 

If we're worried about false positives and overdiagnosis, it seems to me that the obvious solution is to focus on improving the technology for detection, rather than reducing screening and accepting a higher number of deaths.

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You do not understand that these guideline will actually have a far greater impact on the number of women who receive false positives (because there's many more of them, than there are women under 50 diagnosed and successfully treated for breast cancer) and undergo needless anxiety, psychological trauma and unneccessary medical procedures as a result.

 

 

That's actually a two-edged sword, though.

 

Statistically, for every X number of false positives that you eliminate, you're going to have Y more women dying of breast cancer because it was not caught in time.

 

Eliminating false positives and overdiagnosis does not come without a cost.

 

If we're worried about false positives and overdiagnosis, it seems to me that the obvious solution is to focus on improving the technology for detection, rather than reducing screening and accepting a higher number of deaths.

WOW We are in complete agreement, for the record my wife has been one of the false positives it involved a more detailed test that showed that the original test was a false positive. I'm sure she would rather have a few weeks of needless worry, over finding out to late that she had cancer - that worry lasts the rest of your life.

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What I find rather humourous, is that the same people saying that everyone should be screened, because one life saved would be worth it, are probably the same people who get all bent out of shape when the government tells them they have to wear helmets on bikes and motorcycles. :lol:

 

I think there is a substantially difference. I don't think anyone is mandating that everyone be screened every year and get a fine if they don't (like a helmet law), so much as mandating that said screening can not be denied by insurers. So everyone that wants to get screened after 40 can do so without jumping through massive hoops and paperwork to get the insurance weasels to pay for it.

 

Clearly you can see the benefits to our system, where the insurers will be on this like a duck on a bug to try and deny payment for care.

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You do not understand that these guideline will actually have a far greater impact on the number of women who receive false positives (because there's many more of them, than there are women under 50 diagnosed and successfully treated for breast cancer) and undergo needless anxiety, psychological trauma and unneccessary medical procedures as a result.

 

 

That's actually a two-edged sword, though.

 

Statistically, for every X number of false positives that you eliminate, you're going to have Y more women dying of breast cancer because it was not caught in time.

 

Eliminating false positives and overdiagnosis does not come without a cost.

 

If we're worried about false positives and overdiagnosis, it seems to me that the obvious solution is to focus on improving the technology for detection, rather than reducing screening and accepting a higher number of deaths.

 

 

 

 

Why is it so hard for you to trust that these recommendations are made with the best interests of women in mind? They look at risks, and they look at benefits. The benefits to asymptomatic women, with no history of BC in their familes, are outweighed by the risks. The science supports that.

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You do not understand that these guideline will actually have a far greater impact on the number of women who receive false positives (because there's many more of them, than there are women under 50 diagnosed and successfully treated for breast cancer) and undergo needless anxiety, psychological trauma and unneccessary medical procedures as a result.

 

 

That's actually a two-edged sword, though.

 

Statistically, for every X number of false positives that you eliminate, you're going to have Y more women dying of breast cancer because it was not caught in time.

 

Eliminating false positives and overdiagnosis does not come without a cost.

 

If we're worried about false positives and overdiagnosis, it seems to me that the obvious solution is to focus on improving the technology for detection, rather than reducing screening and accepting a higher number of deaths.

WOW We are in complete agreement, for the record my wife has been one of the false positives it involved a more detailed test that showed that the original test was a false positive. I'm sure she would rather have a few weeks of needless worry, over finding out to late that she had cancer - that worry lasts the rest of your life.

 

 

Good for your wife, but studies show that the anxiety and psychological distress women face after a false positive lasts longer than the time it takes to be cleared, and in some cases, may discourage them from getting future mammograms.

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This is interesting on several levels. First, the debate among the professionals which is somewhat diverse and I have already heard several clinicians versus academians arguements. It will be interesting to follow.

 

Second and even more interesting to me is the layperson objections to the findings as if any amount of money should be paid for any test even those which do not have a statistically significant chance of finding/preventing disease and curing or improving outcomes ie. lowering morbidity and mortality. This is precisely why medical decisions should never be in the hands of politicians subject to pressure from the electorate or insurers. Frankly, if it turns out that there is little statistical value in the test......meaning it does not change the number of women whose disease is caught early or managed better.....then insurers should question the validity of payment for persons who insist - absent other mitigating factors - on having one anyway. If you don't care that the test prior to a certain age does not improve your chances of detecting the disease and want to pay for it yourself go ahead. But I have no desire for your uninformed or ultra conservative view to contribute to driving up overall health care costs and making unnecessary tests a standard of care. In my mind its analogous to saying that since there is some very small number of 20 year olds who anomalously die of colon cancer that could have been detected by a colonoscopy that therefore all 20 year olds should have colonoscopies and that insurers should pay.

 

Ultimately, I think its about being an informed partner in your own medical care, seeking a doctor willing to discuss/explain your situation, reading up and becoming informed on the possible choices and then moving forward according to your judgment and decisions.

 

No this is not some discriminatory practice against women......at least not yet. This is mostly reasoned debate in the scientific community about evidence based standards of care. We should be vigilant that it does not result in changes in coverage until the issue is fully vetted by the scientific community.

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This is interesting on several levels. First, the debate among the professionals which is somewhat diverse and I have already heard several clinicians versus academians arguements. It will be interesting to follow.

 

Second and even more interesting to me is the layperson objections to the findings as if any amount of money should be paid for any test even those which do not have a statistically significant chance of finding/preventing disease and curing or improving outcomes ie. lowering morbidity and mortality. This is precisely why medical decisions should never be in the hands of politicians subject to pressure from the electorate or insurers. Frankly, if it turns out that there is little statistical value in the test......meaning it does not change the number of women whose disease is caught early or managed better.....then insurers should question the validity of payment for persons who insist - absent other mitigating factors - on having one anyway. If you don't care that the test prior to a certain age does not improve your chances of detecting the disease and want to pay for it yourself go ahead. But I have no desire for your uninformed or ultra conservative view to contribute to driving up overall health care costs and making unnecessary tests a standard of care. In my mind its analogous to saying that since there is some very small number of 20 year olds who anomalously die of colon cancer that could have been detected by a colonoscopy that therefore all 20 year olds should have colonoscopies and that insurers should pay.

 

Ultimately, I think its about being an informed partner in your own medical care, seeking a doctor willing to discuss/explain your situation, reading up and becoming informed on the possible choices and then moving forward according to your judgment and decisions.

 

No this is not some discriminatory practice against women......at least not yet. This is mostly reasoned debate in the scientific community about evidence based standards of care. We should be vigilant that it does not result in changes in coverage until the issue is fully vetted by the scientific community.

 

But that's not what the recommendation says.

 

It says that for every 1900 women screened in the 40-49 age group, one mortality will be prevented, versus 1300 women in the 50-59 age group. It doesn't say anything at all about "statically insignificant." They've basically just drawn a line (some might argue arbitrarily) that says 1300 is worth it and 1900 isn't.

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You do not understand that these guideline will actually have a far greater impact on the number of women who receive false positives (because there's many more of them, than there are women under 50 diagnosed and successfully treated for breast cancer) and undergo needless anxiety, psychological trauma and unneccessary medical procedures as a result.

 

 

That's actually a two-edged sword, though.

 

Statistically, for every X number of false positives that you eliminate, you're going to have Y more women dying of breast cancer because it was not caught in time.

 

Eliminating false positives and overdiagnosis does not come without a cost.

 

If we're worried about false positives and overdiagnosis, it seems to me that the obvious solution is to focus on improving the technology for detection, rather than reducing screening and accepting a higher number of deaths.

 

 

 

 

Why is it so hard for you to trust that these recommendations are made with the best interests of women in mind? They look at risks, and they look at benefits. The benefits to asymptomatic women, with no history of BC in their familes, are outweighed by the risks. The science supports that.

 

I see that you're not interested in addressing the point I made.

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[quote name='wabbiteer' post='2576744' date='Nov 19 2009, 01:15 PM'

Why is it so hard for you to trust that these recommendations are made with the best interests of women in mind? They look at risks, and they look at benefits. The benefits to asymptomatic women, with no history of BC in their familes, are outweighed by the risks. The science supports that.

I think "the best interests of women" could be formulated any number of ways and many feel the weighting put on the adverse consequences of overdiagnosis was excessive. As has become obvious this week, many women would rather risk a false positive and all it entails for the small chance of finding a malignancy earlier than otherwise. I suggest we save our opprobrium for those questioning the good faith of the panel or the absolute necessity of the expert consensus process for the practice of medicine, let alone health care policy. That doesn't seem to include Wabbiteer or TMSail.

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You do not understand that these guideline will actually have a far greater impact on the number of women who receive false positives (because there's many more of them, than there are women under 50 diagnosed and successfully treated for breast cancer) and undergo needless anxiety, psychological trauma and unneccessary medical procedures as a result.

 

 

That's actually a two-edged sword, though.

 

Statistically, for every X number of false positives that you eliminate, you're going to have Y more women dying of breast cancer because it was not caught in time.

 

Eliminating false positives and overdiagnosis does not come without a cost.

 

If we're worried about false positives and overdiagnosis, it seems to me that the obvious solution is to focus on improving the technology for detection, rather than reducing screening and accepting a higher number of deaths.

 

 

 

 

Why is it so hard for you to trust that these recommendations are made with the best interests of women in mind? They look at risks, and they look at benefits. The benefits to asymptomatic women, with no history of BC in their familes, are outweighed by the risks. The science supports that.

 

I see that you're not interested in addressing the point I made.

 

 

 

The answer to the point you made is widely available in medical research and reports.

No, i don't feel like googling for you.

 

Where should we start with the points you've chosen not to address???

 

People die every day because they weren't screened for every possible cause of death. I think it's entirely prudent to not suggest all women, regardless of risk, are screened using a tool thats accuracy and usefullness is a source of great debate in medical circles, particularly when used for pre-menopausal women.

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its very simple -- people will die that wouldn't have before

So, why not screening mammography at age 30? Why not colonoscopy at 40? Why not whole-body MRI for everyone at age 50? All will detect malignancies and prevent deaths that are occurring under current practices.

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What I find rather humourous, is that the same people saying that everyone should be screened, because one life saved would be worth it, are probably the same people who get all bent out of shape when the government tells them they have to wear helmets on bikes and motorcycles. :lol:

 

I think there is a substantially difference. I don't think anyone is mandating that everyone be screened every year and get a fine if they don't (like a helmet law), so much as mandating that said screening can not be denied by insurers. So everyone that wants to get screened after 40 can do so without jumping through massive hoops and paperwork to get the insurance weasels to pay for it.

 

Clearly you can see the benefits to our system, where the insurers will be on this like a duck on a bug to try and deny payment for care.

Agreed They already try to deny claims if the friggin appointment is not 365 days apart. 357 will get a letter denying the claim. They ignore the simple fact that Doctor appointments can vary each year.

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its very simple -- people will die that wouldn't have before

So, why not screening mammography at age 30? Why not colonoscopy at 40? Why not whole-body MRI for everyone at age 50? All will detect malignancies and prevent deaths that are occurring under practices.

 

What are the detection rates for a PAP smear? How many people are tested to prevent one death? Is the number really that much lower than 1,900? Given the incidence of cervical cancer deaths and the ubiquity of testing, I doubt it.

 

Here are the same organization's recommendations for cervical cancer screening. Bizarrely, they seem to have used an entirely different set of benchmarks to set their recommendations (specifically, the issue of false positives is barely addressed, where it is a huge factor in the breast cancer recommendations). There is no assessment of how many screenings are needed to prevent one mortality.

 

http://www.ahrq.gov/clinic/uspstf/uspscerv.htm

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It says that for every 1900 women screened in the 40-49 age group, one mortality will be prevented, versus 1300 women in the 50-59 age group. It doesn't say anything at all about "statically insignificant." They've basically just drawn a line (some might argue arbitrarily) that says 1300 is worth it and 1900 isn't.

 

First, your question is exactly the kind of reasoned scrutiny that is healthy in the debate. Far different from "I knew someone who had breast cancer caught by mammography at 40 therefore all women 40 and older should have mammography" kind of debate.

 

Second, the question of where to draw the line is indeed an interesting part of the debate. I don't judge it arbitrary but the rationale for where the line should be placed is at the heart of the debate. How many? Well in the recommendation 1 mortality per 600 screenings is the delta. What is absent in the equation is the cost differential in the two scenarios. In public health its often a cost/benefit question....not simply a benefit/benefit question.

 

Lastly................I've not decided myself. I'm still following the debate. Its early.

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What are the detection rates for a PAP smear? How many people are tested to prevent one death? Is the number really that much lower than 1,900? Given the incidence of cervical cancer deaths and the ubiquity of testing, I doubt it.

 

Here are the same organization's recommendations for cervical cancer screening. Bizarrely, they seem to have used an entirely different set of benchmarks to set their recommendations (specifically, the issue of false positives is barely addressed, where it is a huge factor in the breast cancer recommendations). There is no assessment of how many screenings are needed to prevent one mortality.

 

http://www.ahrq.gov/clinic/uspstf/uspscerv.htm

I don't know much about cervical or breast cancer or cancer in general and I'm sure I'm showing it here, but it may be relevant that cervical cancer doesn't metastasize early or aggressively like breast. Also, Pap smears are a very different kind of test with less ambiguity than a mammogram. The results are graded for the degree of abnormality, not all or nothing like a mammogram, and are often repeated over a period of time before any action is taken. All in all, and this I do know, an abnormal Pap is usually a less urgent situation than suspected breast tumor and one which, I believe, leads to fewer unnecessary invasive procedures.

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its very simple -- people will die that wouldn't have before

So, why not screening mammography at age 30? Why not colonoscopy at 40? Why not whole-body MRI for everyone at age 50? All will detect malignancies and prevent deaths that are occurring under practices.

 

What are the detection rates for a PAP smear? How many people are tested to prevent one death? Is the number really that much lower than 1,900? Given the incidence of cervical cancer deaths and the ubiquity of testing, I doubt it.

 

Here are the same organization's recommendations for cervical cancer screening. Bizarrely, they seem to have used an entirely different set of benchmarks to set their recommendations (specifically, the issue of false positives is barely addressed, where it is a huge factor in the breast cancer recommendations). There is no assessment of how many screenings are needed to prevent one mortality.

 

http://www.ahrq.gov/clinic/uspstf/uspscerv.htm

 

 

 

Are you going to answer the question he posed?

 

Interesting statistics, which highlight *some* of the reasons that Pap smears are suggested for all women, not just older ones:

 

From 2002-2006, the median age at death for cancer of the cervix uteri was 57 years of age4 Approximately 0.0% died under age 20; 5.3% between 20 and 34; 16.2% between 35 and 44; 23.2% between 45 and 54; 20.1% between 55 and 64; 15.2% between 65 and 74; 13.1% between 75 and 84; and 6.9% 85+ years of age.

 

From 2002-2006, the median age at death for cancer of the breast was 68 years of age4 Approximately 0.0% died under age 20; 1.0% between 20 and 34; 6.2% between 35 and 44; 15.1% between 45 and 54; 20.3% between 55 and 64; 19.8% between 65 and 74; 22.8% between 75 and 84; and 14.9% 85+ years of age.

 

Moe, you are exactly correct in the difference between Paps and mammograms.

Pap smears are screening and diagnostic tests in one procedure. Mammograms can only tell you (accurately 2/3 of the time) if there is a mass, not whether it's cancer, not whether it is malignant or benign, not where it would resolve on it's own, etc etc.

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So how's that public healthcare looking now. This is just the beginning of a long road to low quality healthcare with the decision made by "expert panels" instead of doctors.

 

Also from the Sydney Morning Herald http://www.smh.com.au/national/doctors-sick-of-failure-to-fix-ailing-hospitals-20091118-imjr.html

It's a guideline not a medical decision. Government and private bodies have been issuing them for decades. Doctors need them because they support decision making, make it easier to get insurers to pay for things, and provide the best possible defense against allegations of negligence by establishing standards of care. Do you think your insurer would just spring for screening colonoscopy for everyone if there weren't guidelines recommending it?

 

If insurance companies had to compete for customers on a national basis they would. As it stands now some state insurance companies have near monopolies in thier respective states. But competition is not what the BHO administration want's

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What I find rather humourous, is that the same people saying that everyone should be screened, because one life saved would be worth it, are probably the same people who get all bent out of shape when the government tells them they have to wear helmets on bikes and motorcycles. :lol:

 

I think there is a substantially difference. I don't think anyone is mandating that everyone be screened every year and get a fine if they don't (like a helmet law), so much as mandating that said screening can not be denied by insurers. So everyone that wants to get screened after 40 can do so without jumping through massive hoops and paperwork to get the insurance weasels to pay for it.

 

Clearly you can see the benefits to our system, where the insurers will be on this like a duck on a bug to try and deny payment for care.

Agreed They already try to deny claims if the friggin appointment is not 365 days apart. 357 will get a letter denying the claim. They ignore the simple fact that Doctor appointments can vary each year.

 

Do NOT get me wound up on this...

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its very simple -- people will die that wouldn't have before

So, why not screening mammography at age 30? Why not colonoscopy at 40? Why not whole-body MRI for everyone at age 50? All will detect malignancies and prevent deaths that are occurring under current practices.

 

 

and this is bad why?

 

I spent 3}k to go to Mayo for a full up physican 5 years ago. They did shit to me you can't imagine. I gladly paid. It began the path that eventually found my hyperparathroid. I was basically saved from serious osteoporosis later in life. And it found some skin cancer. And, guess what -- it caught a friend of mines colon cancer (he was 41) cause they did a sigmoidoscopy. If he had waited to normal procedures, he would be dead now. His name is Mike. He isn't a statistic to me. He is a friend who is alive -- minus 18 inches of bowel.

 

That said, over the next couple years -- if the gov't stays out of the way -- we will be getting full up genetic scans will identify "probabilities" that will in turn drive "individualized" health care diagnostic plans. The heart of todays problem is that we use testing schedules that are generic -- and people aren't generic. Or, as you point out -- its a damn good idea for everyone to get full body MRIs. I know that as a person concerned with my health -- and with some ching in my pocket -- I will spend for it. But then, under this approach, us rich folks get what the poor don't. Ok, i got no prob with that. The poor can get rationing like you support.

 

Us rich, we will get high deductible plans, pump money into our HSAs -- and use it to get diagnostic tests that wouldn't be covered otherwise. Or, maybe I will get ass implants -- my ass is getting flat like an old white guy.

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I don't see how this is taking away women's rights(whatever that means). Feel your bewbies every month (just like you guys should be doing with your nuts every month). You know them best, the lumps that are always there and that change during your menstrual cycle. If something feels different, go see a doctor. If you want a mammogram, go get a mamogram. No one is saying that radiologists will no longer be allowed to give one to anyone under a certain age. I really don't see what the big deal is.

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I don't see how this is taking away women's rights(whatever that means). Feel your bewbies every month (just like you guys should be doing with your nuts every month). You know them best, the lumps that are always there and that change during your menstrual cycle. If something feels different, go see a doctor. If you want a mammogram, go get a mamogram. No one is saying that radiologists will no longer be allowed to give one to anyone under a certain age. I really don't see what the big deal is.

 

The big deal is who pays for it...insurers WILL latch onto this as a reason to make you pay for the mammogram when you find that lump.

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The big deal is who pays for it...insurers WILL latch onto this as a reason to make you pay for the mammogram when you find that lump.

Yeah. Should have read the thread and not skimmed it. It is not like me to be late to the party.

 

Never having had insurance, I don't quite view it that way. Buncha crooks they are.

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Heard a very interesting segment on the topic on NPR this afternoon and have softened my opinion. Turns out that the same panel recommended that women should not be trained in self exams. The research shows that those who've been taught how to do self exams are on par for catching lumps with women who find lumps without going through the official breast exam protocol. No statistical difference.

 

As per mammograms - I think it's best to leave it up to the doctor in consultation with his/her patient.

 

I also think it is irresponsible for some federal task force to suggest guidelines that insurance companies can cite for refusing the test. Bad form, that.

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The big deal is who pays for it...insurers WILL latch onto this as a reason to make you pay for the mammogram when you find that lump.

Yeah. Should have read the thread and not skimmed it. It is not like me to be late to the party.

 

Never having had insurance, I don't quite view it that way. Buncha crooks they are.

 

Total weasels. If you are paying for it you can get a mammogram every week if you want.

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BTW my wife's initial take on this is that 1) it is ultimately a financially motivated recommendation no matter what they are swearing about it and 2) it is a BAD guideline to go backwards in the care level we are providing and will lead to more deaths from undetected cancer. In particular, ANYTHING marginal like this that gives the insurance companies any excuse to deny care is a bad thing from her perspective because it will make it that much more difficult for her to care for her patients.

 

Bad guideline because we've gotten women really aware of it now after a generation of training and are paying close attention and this will undo that. Breast cancer is on the rise in women in their 40's and she see's anything that decreases catching it as a bad idea. She also views a 15% increase in the mortality rate as not insignificant at all.

 

We had a good friend recently, mid 40's, found a lump through a BSE and get it checked out and it was cancer. No family risk factors - absolutely one of the woman who would not be eligible for a mammogram for another five years or so. She might well have been one of the 15% added on to the mortality rate, though of course she's not out of the woods yet anyway. She is not the first or the second woman we know personally with a similar story. That is anecdotal, but the rise in cancer rates is not.

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So what does your wife think about the suggestion, in place for several years, that BSE not be taught anymore and is ineffective?

 

I mean technically speaking, women DO find lumps through BSE, but the overall benefit has been deemed too insignificant to warrant generally instructing women on the practice. How is that any different than mammograms under 40?

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As per mammograms - I think it's best to leave it up to the doctor in consultation with his/her patient.

 

I also think it is irresponsible for some federal task force to suggest guidelines that insurance companies can cite for refusing the test. Bad form, that.

How is this theoretical doctor, most likely an overworked primary care doc, trained in internal medicine or family medicine, supposed to know when to screen? Guidelines, that's how. The current guidelines say age 40. If some panel had recommended screening at 40 instead of 30, some, certainly not all, but some, of the same people would be making the same arguments based on individual cases of very young women having their cancers diagnosed with screening mammograms. Try going to your insurance company at age 48 and asking for a screening colonoscopy.

 

The American College of Obstetrics and Gynecology, another tentacle of the International Socialist Conspiracy Against Womens' Health, just recommended waiting until age 21 to do the first Pap smear. This means war! Let's abolish any attempt to influence medical practice with empirical data! Let's close down clinical research! Let's let every doc 10, 20, 30 years out of training just wing it, based on what they're able to piece together from a huge and disorganized literature, and suffer the consequences in the courts! Populism is going to solve all of our problems.

 

By the way, this is not a Federal Task Force, it's a bunch of leading public health experts from universities whom the government assembled in a nice hotel in DC, just like they do for grant review, scientific meetings, oversight of NIH institutes, etc., etc., etc.. The agency people provide a buffet, give a 2 minute charge to the group, take notes, and shut the hell up when the chair takes over.

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The past few days since the U.S. Preventive Services Task Force announced their recommendations on mammography and breast exams. I've been concerned about what could be interpreted as a trade off vs. cost that panels such as this can/will be making (policy?) in the possible future of American health choices under the "reform" presently being rushed through congress. This hits me in two ways, since I am not an advocate of the current direction of healthcare "reform" in the U.S. Additionally, being the single male in a family pretty much dominated by women, most recently a younger sister, 7 years in remission from breast cancer, then of course my personal enjoyment in performing exams on my girlfriend. I really see this recommendation as a negative toward the health choices of women in general. Am I reading into this too much? Am I making an emotional decision versus a fact based one?

 

Link

Diane Rehm Today

If I understand it correctly, the only change was to recommend that woman at 40 consult with their physician whether or not to have annual mammogrophy rather than schedule the procedure automatically.

 

 

 

 

+1

 

It was a recommendation... Geesh! all this hub-bub over a recommendation.

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So what does your wife think about the suggestion, in place for several years, that BSE not be taught anymore and is ineffective?

 

I mean technically speaking, women DO find lumps through BSE, but the overall benefit has been deemed too insignificant to warrant generally instructing women on the practice. How is that any different than mammograms under 40?

That has not been her experience - that it is effective. She has had more than a few patients come in having found stuff that needs further examination. I suppose it depends on how well you teach it and how well your patients use it.

 

Not ineffective as in > 0% of patients that do it find stuff. Maybe it is not as effective as it could be the way it is done now, and the way patients do it.

 

I can not imagine that telling women NOT to pay attention to their bodies is a good idea.

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The past few days since the U.S. Preventive Services Task Force announced their recommendations on mammography and breast exams. I've been concerned about what could be interpreted as a trade off vs. cost that panels such as this can/will be making (policy?) in the possible future of American health choices under the "reform" presently being rushed through congress. This hits me in two ways, since I am not an advocate of the current direction of healthcare "reform" in the U.S. Additionally, being the single male in a family pretty much dominated by women, most recently a younger sister, 7 years in remission from breast cancer, then of course my personal enjoyment in performing exams on my girlfriend. I really see this recommendation as a negative toward the health choices of women in general. Am I reading into this too much? Am I making an emotional decision versus a fact based one?

 

Link

Diane Rehm Today

If I understand it correctly, the only change was to recommend that woman at 40 consult with their physician whether or not to have annual mammogrophy rather than schedule the procedure automatically.

 

 

 

 

+1

 

It was a recommendation... Geesh! all this hub-bub over a recommendation.

 

The problem is that insurance companies will use that recommendation to fight paying for mammograms for women under 50 now, whether they need them or not.

 

They do that all the time with other recommendations, this just gives them one more tool to try and deny care to patients that need it.

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The mammogram debated is a clear harbinger of what will come our way under Obamacare. This is what happens when we allow politics into medicine. Decisions about medical care need to be made by patients and their doctors, not politics. Those of you who advocate this course, putting bureaucrats in charge of rationing care, have no idea what this will do to the cost or quality of care, the effect on innovation in medicine or on our individual liberty as a results. It's a bad road these statists want to put us on.

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So what does your wife think about the suggestion, in place for several years, that BSE not be taught anymore and is ineffective?

 

I mean technically speaking, women DO find lumps through BSE, but the overall benefit has been deemed too insignificant to warrant generally instructing women on the practice. How is that any different than mammograms under 40?

That has not been her experience - that it is effective. She has had more than a few patients come in having found stuff that needs further examination. I suppose it depends on how well you teach it and how well your patients use it.

 

Not ineffective as in > 0% of patients that do it find stuff. Maybe it is not as effective as it could be the way it is done now, and the way patients do it.

 

I can not imagine that telling women NOT to pay attention to their bodies is a good idea.

 

Of, it's effective. It's effective at getting people into her office.

 

Study after study has shown that BSE has no impact on mortality rates, and leads to a large number of benign biopsies. hence why it hasn't been taught to women in many years.

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The mammogram debated is a clear harbinger of what will come our way under Obamacare. This is what happens when we allow politics into medicine. Decisions about medical care need to be made by patients and their doctors, not politics. Those of you who advocate this course, putting bureaucrats in charge of rationing care, have no idea what this will do to the cost or quality of care, the effect on innovation in medicine or on our individual liberty as a results. It's a bad road these statists want to put us on.

 

 

Um, there are far more people rationing care now, in the form of insurance company administrators, than there likely would be under public health care. the difference is, currently their only real concern is profits and shareholders, as opposed to the outcomes for those they are responsible for funding care for.

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The mammogram debated is a clear harbinger of what will come our way under Obamacare. This is what happens when we allow politics into medicine. Decisions about medical care need to be made by patients and their doctors, not politics. Those of you who advocate this course, putting bureaucrats in charge of rationing care, have no idea what this will do to the cost or quality of care, the effect on innovation in medicine or on our individual liberty as a results. It's a bad road these statists want to put us on.

I don't really like what I've seen so far and the next few years (decades?) may suck for this country, but the reaction among market absolutists and other particularly annoying groups will have some entertainment value.

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The past few days since the U.S. Preventive Services Task Force announced their recommendations on mammography and breast exams. I've been concerned about what could be interpreted as a trade off vs. cost that panels such as this can/will be making (policy?) in the possible future of American health choices under the "reform" presently being rushed through congress. This hits me in two ways, since I am not an advocate of the current direction of healthcare "reform" in the U.S. Additionally, being the single male in a family pretty much dominated by women, most recently a younger sister, 7 years in remission from breast cancer, then of course my personal enjoyment in performing exams on my girlfriend. I really see this recommendation as a negative toward the health choices of women in general. Am I reading into this too much? Am I making an emotional decision versus a fact based one?

 

Link

Diane Rehm Today

If I understand it correctly, the only change was to recommend that woman at 40 consult with their physician whether or not to have annual mammogrophy rather than schedule the procedure automatically.

 

 

 

 

+1

 

It was a recommendation... Geesh! all this hub-bub over a recommendation.

 

The problem is that insurance companies will use that recommendation to fight paying for mammograms for women under 50 now, whether they need them or not.

 

They do that all the time with other recommendations, this just gives them one more tool to try and deny care to patients that need it.

 

 

Sounds scary.... Wonder what the government HC would say? :rolleyes:

 

As knowledge is gained and early symptoms are known.... It should be the patient and doctor's decision on whether or not to put in place an expensive routine procedure. All this study shows, is that 'routine' is wasted on most women between 40-50.

 

Sounds like an excellent study on how as a society we can cut down on HC Costs... by limiting 'routine' to those that need 'routine'.

 

But go ahead and scare yourself with the evil insurance company talk... you won't have that option for long.

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Rumballs, it's actually not the procedure which is expensive. It's the follow up.

A mammogram costs between 100- 200 bucks. Not a lot really.

But women under 50 have dense breast tissue which makes it much more difficult to read. Because of that, they are at a significantly increased risk of false positives and false negatives (in a demographic where breast cancer itself is uncommon, and whn it occurs, they are at a higher risk of mortality, regardless of screening, because of the aggressive nature of it). When you have a false positive, that's when it gets expensive--follow up ultrasound or mammogram, specialists, and biopsies--for benign growths.

 

This is why the recommendation was made inthe US, and why throughout most of the world, women under 50 aren't screened UNLESS they have clear risk factors--there is simply more to lose in the way of unnecessary procedures, than there is likely to gain.

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