Hope & Change in America, Mammogram Edition

Who could have predicted a new federal recommendation calling for less frequent mammograms?

Oh wait, I did. In May I wrote at length about how American mammography recommendations differ from those in places like Canada and the United Kingdom where cost containment goals determine testing guidelines:

Of women who receive annual screening mammography beginning at age 40, six out of 10,000 over a decade will have their lives saved.  Breast cancer will be detected and cured in many more, but regular mammograms will only make a life or death difference for six of every 10,000 women in that group.  Mammograms are of extremely high value to those women and their families, but don’t offer much bang for the buck when it comes to the other 9,994 women.

And wringing more bang from every health care buck is reason enough for Canadian and British recommendations that women wait until age 50 to begin receiving screening mammographies.  In these countries where cost-effectiveness studies influence health policy and medical practice, six saved lives aren’t worth the substantial costs associated with all those extra mammograms and the false positives they sometimes produce.

It is hardly shocking that the breast cancer mortality is 9 percent higher in Canada and 88 percent higher in the United Kingdom.  Nine of 10 middle-aged American women (89 percent) have had a mammogram, compared to less than three-fourths of Canadians (72 percent).  And British and Canadian patients wait for care about twice as long as Americans.

There are indeed valid criticisms American health care, but one area in which we excel is that we don’t base guidelines for care on cost-utility analysis. That’s why the U.S. ranks first in providing the “right care” for a given condition and has the best survival rate for breast cancer.

Obamacare may force Americans to give up those bragging rights.

Starting right about … now:

“We’re not saying women shouldn’t get screened. Screening does saves lives,” said Diana B. Petitti, vice chairman of the U.S. Preventive Services Task Force, which released the recommendations Monday in a paper being published in Tuesday’s Annals of Internal Medicine. “But we are recommending against routine screening. There are important and serious negatives or harms that need to be considered carefully.”

Those “important and serious negatives” are anxiety and the risk of false positives. Shockingly, not everyone agrees that the risks outweigh the benefits of early detection.

But the American Cancer Society, the American College of Radiology and other experts condemned the change, saying the benefits of routine mammography have been clearly demonstrated and play a key role in reducing the number of mastectomies and the death toll from one of the most common cancers.

Tens of thousands of lives are being saved by mammography screening, and these idiots want to do away with it,” said Daniel B. Kopans, a radiology professor at Harvard Medical School. “It’s crazy — unethical, really.

As I wrote in May, “I’ll be saving up for a date with a mammography machine in one of those thriving medical tourism meccas.”

Memeorandum has much more from the blogosphere on the new federal guidelines. Ed Morrissey reminds us that the very same federal panel developed the mammography guidelines we’ve been using, and Sister Toldjah asks, “What’s changed? Hmmmm….

Yes, what could it be?


3 Responses to “Hope & Change in America, Mammogram Edition”

  1. Chrissy on November 18th, 2009 1:14 pm

    I see the point in cutting costs. All these tests cost lots of money, however, I see the point made about ‘Tens of thousands of lives are being saved by mammography screening.’
    So how do we do both?
    I’ve been reading Norman Makous, M.D book called, Time to Care It’s directed primarily to readers in the general public who are concerned about the quality of their medical care and how it is changing today. This is particularly interesting now as the Obama administration moves towards healthcare reform. In particular, the key points – that personal care by physicians is critical to successful treatment, and that doctors today are no longer providing this personal attention to patients – will be of concern to many people. Given the controversial views, it will generate a great deal of debate and discussion.
    What do you think?

  2. Eclectic Radical on November 22nd, 2009 10:34 am

    This is an issue exciting equal upset on liberal blogs. I do think mammograms serve a useful function and I think the new recommendations go too far in correcting what was a mistake in the other direction by the medical establishment.

    To take a slightly contrarian position, the ‘breast cancer awareness industry’ excited a media hysteria in the 1990s that has never totally gone away. Women (I speak generally, I do not mean all women) were led to believe that breast cancer was the single most important women’s health issue of which they should be aware and should occupy all of their time. Self-exams and too-frequent mammograms have led to many false positives. The craze with genetic testing for increased vulnerability to cancer led to defensive double mastectomies as a purely preventative measure by perfectly healthy women.

    Breast cancer, for a variety of reasons, became a pet project of many feminist groups and movements to the detriment of women’s health concerns that are actually more common and carry a higher mortality rate.

    I think it’s a mistake to so minimize the importance of breast cancer testing, but I think it was a mistake to make breast cancer the most visible women’s health issue in the first place. America, regardless of political party, tends to operate on a panic/dismissal pattern when it comes to health issues. People are in hysteria over the public health risk of the week THIS week and when the next public health risk of the week comes along the last is completely dismissed.

  3. Jenn Q. Public on November 22nd, 2009 5:14 pm

    Eclectic Radical wrote:

    This is an issue exciting equal upset on liberal blogs.

    Of course it is, just like the Stupak amendment caused tremendous upset among liberal bloggers. Most liberals are all for further government interference in health care until it threatens to impact their choices.

    I actually agree wholeheartedly with your “slightly contrarian position.” But I’m sickened by the thought that women, many of whom already avoid mammograms, might use these new reports to justify putting off screening. Individuals (in consultation with their health care providers) should be trusted to assess the risks of false positives and proceed accordingly. I’m glad Kathleen Sebelius came out strongly against changing any guidelines.

    Eclectic Radical also wrote:

    Breast cancer, for a variety of reasons, became a pet project of many feminist groups and movements to the detriment of women’s health concerns that are actually more common and carry a higher mortality rate.

    This is very true. My mother died of lung cancer, the number one cause of cancer deaths in women. Unfortunately, there’s still a huge stigma associated with lung cancer and it just isn’t a trendy cause, so no one’s slapping lung cancer ribbons on bumpers and lapels.

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