For Health or Money: The Motivation Behind New Mammogram Guidelines
Published November 20, 2009 @ 01:40PM PT
Women and health care professionals are confused and outraged by the mammogram guidelines released by the United States Preventive Services Task Force (USPSTF) on Monday, denouncing the task force for prioritizing economy over health.
Regular mammogram screenings have accounted for a 15 percent decrease in the rate of breast cancer. The new guidelines suggest that women start going for regular mammograms at 50 -- ten years later than previously recommended -- and get checked every other year, instead of annually, unless they are at high risk. Critics, such as the American Cancer Society, worry that fewer mammograms will mean a rise in undetected breast cancer, potentially costing women their lives.
Opponents are also concerned that insurance companies will use this as an excuse to refuse to cover mammograms for women under 50. The National Committee for Quality Assurance, a non-profit that grades insurance companies, has already altered its evaluations to reflect the change.
The task force claims that the issue at stake is unnecessary screening and treatment. Women in their forties are 60 percent more likely than older women to have false-positive mammograms; according to Dr. Diana Petitti, vice-chair, this leads to needless medical procedures, such as biopsies, accompanied by high stress. The USPSTF says that the relatively small number of women whose cancer is detected -- only one cancer death is prevented for every 1,904 women screened from age 40 to 49 -- is not worth the anxiety of all those false-positives.
Perhaps that makes sense ... unless, of course, you happen to be one of those women it would save. What really bothers me here is that the new guidelines seem to be based on the idea that we need to save this country's women from anxiety, rather than substantial medical evidence. It strikes me as harking back to the Victorian era, when medical professionals' number one diagnosis for female patients was hysteria -- an anxiety disorder that, it turned out, doesn't exist.
Why not recommend an increase in education and preparation -- including the realities of false-positives -- rather than a decrease in screening? I imagine prostate exams are no picnic for men, so should we spare them the stress and reduce screening for prostate exams, or do we assume they can handle it because they're men? When it comes to matters of life and death, I think women can handle a little stress.
Photo Credit: Buddhini Ekanayake
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Comments (20)
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Roxy MtJoy is a freelance writer and case manager at a domestic violence shelter. Additionally, she is producing and directing a documentary on women's colleges in the United States, herself a proud graduate of Randolph-Macon Woman's College. Women's rights are something she is very passionate about. That, and the Pittsburgh Steelers. Roxy lives happily with her husband and her cat in Los Angeles.
I was shocked when I heard this report on NPR on Monday. I think it all goes back to the male/female dichotomy... the subject vs. the object. Men define themselves and the world, while women are stripped of their agency. This is ridiculous. Women should be heard when they have real concerns such as this one.
Posted by Juan Portillo on 11/20/2009 @ 02:05PM PT
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From what I've heard, the panel wasn't looking at it in terms of economics. They just saw that it was more effective to screen in the 50s.
I personally am sick of hearing about this.
Insurance companies (which are totally useless....and why we need single-payer) have said they will keep covering mammograms so I don't see what the big deal is. Christ.
Posted by Courtney C............ on 11/20/2009 @ 02:44PM PT
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Courtney, thanks for the feedback. The question isn't whether or not insurance companies will still cover them, but whether or not they will charge higher premiums for plans that include annual mammograms. And, of course, the idea that women who care afford better insurance will still have the same access to screening, but lower-income women may then have to forgo a test they'd normally have done. The panel may or may not have been looking at money, but that does not negate the fact that their guidelines will have an economic impact.
Posted by Roxann MtJoy on 11/20/2009 @ 03:10PM PT
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The best way to prevent disparities between low income and higher income women when it comes to access to mammograms is to rally in support of a single-payer system.
Posted by Courtney C............ on 11/22/2009 @ 02:44PM PT
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I think preventing one death per 1,904 is a lot, and totally worth it.
I agree about the comparison to hysteria! It's funny that I have mostly heard men being interviewed on this subject all week (in defense of the new guidelines). I almost spit out my coffee on the way to work when I heard a man explaining how stressful it is for a girl to get her first pap smear.
Posted by J C on 11/20/2009 @ 07:45PM PT
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LOL are you serious?! that is hilarious and disturbing...
Posted by Juan Portillo on 11/20/2009 @ 10:56PM PT
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Not to mention male chauvinistic...
But then, the fact that few if any women were asked for their opinions is even more male chauvinistic and it illustrates just how much work there still is to ensure true equality and protect the rights of women.
Posted by Reverend Boony on 11/21/2009 @ 04:09AM PT
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Unneccessary screening my ass...
The greedy bastards just want more money at the expense of women's health and lives.
Posted by Reverend Boony on 11/21/2009 @ 04:06AM PT
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A mammogram is a "test". A test might determine if breast cancer is present but a test will have NO affect on the rate of occurence of brast cancer. The 15% decrease in the rate of breast cancer, if true, would NOT be caused by a test.
Posted by alfred sasiadek on 11/21/2009 @ 03:01PM PT
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Hi Alfred. the task force wording you are referring to (15% reduction in the rate of breast cancer) can be a little confusing, so I did a little digging. It is a 15% reduction in breast cancer deaths among the women who had mammograms. I hope that helps clarify.
Posted by Roxann MtJoy on 11/21/2009 @ 07:00PM PT
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This, sadly, is part of a much larger propaganda campaign to "ration" healthcare by somehow convincing us that "we never really needed these tests in the first place". Thankfully we are not living in the 30's or 40's and not as susceptible to this kind false information.
I have spent a lifetime working in radiology. Mammograms save lives! The radiation dose of a digital mammogram today is equal to about the same radiation exposure we all receive from "natural sources" over a 3 month period. The chance of that amount of radiation "causing" an injury (all ionizing radiation has that potential) is about 1 in 500,000 ...Compare that with the fact that 1 in 8 women "will" develop some form of breast cancer in their lifetime. The earlier "any" potential neoplasm (new growth) is identified the better the chance to prevent spreading of the cancer, better chances to save the breast, the better the longterm quality of life for the person.
I agree we have some problems with our healthcare delivery system and its costs, but "pretending" that these technologies/tests don't work, or are unnecessary is wrong!
Posted by David Longton on 11/21/2009 @ 08:09PM PT
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I was in total disbelief when I read this, with all the publicity to get tested earlier and more thoroughly. I plan on getting tested at 25 and every 2-3 years afterwards I would rather be a little poked and prodded than find out I have stage 3 or 4 breast cancer because I waited to too long to get tested.
Posted by crystal Millikan on 11/21/2009 @ 09:19PM PT
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I think the story that's not being told by the media is that a mammogram is one of the best tests we have to screen for breast cancer, and it's not that effective! I wish people would react to this story by saying, "Wow, it looks like mammograms are not as effective as we'd like them to be, Why don't we put some time and resources into developing a better method to catch breast cancer early." I would lvoe to hear that.
Posted by Amanda Kloer on 11/22/2009 @ 11:14AM PT
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I agree wholeheartedly.
I personally will avoid a mammogram like the plague.
Posted by Courtney C............ on 11/22/2009 @ 02:45PM PT
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Good point, Amanda.
Posted by J C on 11/22/2009 @ 03:13PM PT
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So true Amanda.......we've all been lead to believe mammograms are life-savers, which is not entirely true. Self-exam (never give that up no matter what they say) and Thermograms. Thermograms detect cancer 10 years earlier than a mammogram and are relatively inexpensive, plus there's no radiation !!
Natural hormone balancing can and does prevent breast cancer. There are more and more MD's practicing that offer BioIdentical Hormones. Get tested young as we live in a world full of xenoestrogens and are exposed to estrogen earlier and younger. (more men are experiencing breast cancer)
Take control of your own health and well-being! Be your own best advocate ! Research, read, be open-minded....too many of us rely upon and believe everything that comes from our government agencies. Our best interests are not really their top priorities................I smell a rat too ;-))
Posted by Deborah H on 11/23/2009 @ 07:22AM PT
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Not only did the US Preventative Services Task Force change the guidelines of the ages for mammograms, they also reported that women should not do their own breast exams, something most women have been doing for many, many years. This very small and easy exam has saved many lives and is often the first indication of cancer or a benign cyst. There are also reports that pap smears don't need to be done as early as they are, that is when a women is sexual active. I know personally of two women who had pre-cancer cells which were detected form an early pap smear and who are healthy today as the pre-cancer cells were destroyed by a laser procedure. These cells, if left untreated, had a good chance of developing into cancer cells.
WE must ask ourselves two very important questions: Just who benefits from these new guidelines? What exactly is the purpose of delaying preventative care for women?
I am smelling a rat.
Posted by Barbara McNamara on 11/22/2009 @ 09:25PM PT
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I never understood why there was an age limit on mammograms to begin with. Women in their 20s and 30s aren't as *high* risk as 40+, but they still can get breast cancer.
Posted by Gabrielle B on 11/23/2009 @ 07:35AM PT
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Actually, women who are in their 20s and 30s have the highest risk of breast cancer. My sister would be alive today if she had a routine mammogram from age 25 on on. She developed breast cancer at age 32. By the time she found a lump it was already too late. She died at age 37, leaving three teenage boys and a heart broken family.
We should do every single thing we can to make sure we get tested for cancer. I really don't care what the so-called experts say. They have their own reasons and sadly, sometimes their own agenda. It may be too late if we delay.
Posted by Barbara McNamara on 11/23/2009 @ 12:45PM PT
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Anyone interested in understanding this topic and whether they should be tested should read a book called: "Should I be Tested for Cancer? Maybe Not and Here's Why" by H. Gilbert Welch, MD. Me personally - I think it should be required reading for any consumer of U.S. health care. (Full Disclosure: I have no stake in the book.) While it seems logical on first blush to screen for cancer and it is what we've been sold, to make an informed decision, you have to look further. There is much wrong with testing. There's no "rat." Testing has it's issues and they're big ones.
Posted by Kelly Meinig on 11/23/2009 @ 12:19PM PT
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