Mammogram Debate

[Not My Real Name]

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.

 

[Mark K]

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...

 

[MoeAlfa]

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.

 

[wabbiteer]

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.

 

[MoeAlfa]

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.

 

[flaps15]

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

 

[NautiGirl]

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."

 

[MoeAlfa]

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.

 

[Regatta Dog]

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.

 

[MoeAlfa]

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.

 

[MoeAlfa]

"Obama's fixin' death panels for your mama," the misogyny gambit, and other idiotic responses to the USPSTF recommendations

Orac says it much better, and at much greater length, than I can.

 

[TMSAIL]

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.

 

[NautiGirl]

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.

 

[TMSAIL]

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.

 

[NautiGirl]

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.

 

[NautiGirl]

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:

 

[wabbiteer]

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.

 

[TMSAIL]

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.

 

[Not My Real Name]

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.

 

[NautiGirl]

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.