Mammogram Debate

flaps15

Super Anarchist
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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

 
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Not My Real Name

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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.

 

austin1972

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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.

 

akaGP

Super Anarchist
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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.

 

austin1972

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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!

 
O

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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.

 

MoeAlfa

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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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flaps15

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It would be good to get a woman's perspective on this subject. MSG? ELLE? BOWGIRL? GINA? Heck, I'd even attempt to listen to Nautigirl's banter on this subject.

 

NautiGirl

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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.

 

roundthebuoys

Super Anarchist
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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?

 

akaGP

Super Anarchist
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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.

 

flaps15

Super Anarchist
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dna level c
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.

 

NautiGirl

Super Anarchist
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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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MoeAlfa

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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.

 

MoeAlfa

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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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NautiGirl

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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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