I'm looking at the news and, above all, the comments about the latest recommendation that women under 50 don't need routine mammograms. I know it's early in the news cycle, but I'm already discouraged at the lack of depth in the discussion and the knee-jerk reactions. Don't get me wrong: This is a serious subject and one that touches close to home for me and every woman that I know, but I can't hop on the outrage bandwagon. Instead, I see this episode revealing some ugly truths about the U.S. health care crisis and causing Americans on all sides of the reform debate to abandon their talking points. Funny how boobs can be so distracting.
First, I'm amazed at the number of people who rail against universal health care but are appalled by this report and its recommendation. Yep, it's quite a different story when they have to think about paying for these services out of their own pockets, isn't it? Suddenly, it's their God-given right to have a mammogram whenever they want it, and paid for by health insurance. All I can say is -- wow.
Second, the mammogram controversy sums up the American approach to health care consumption in a nutshell. We want to consume more and more care, regardless of the cost or the actual outcome. But the one common ground that both parties were able to reach on health care reform is cost control -- and that is exactly what this new recommendation is. Digest that for a moment. This is what cost control looks like: It's not rationing, it's not socialized medicine, it's cost control. What are the real outcomes, and what are the real costs? Do the math. Cover what makes sense. Leave the rest up to the patient - they can pay for additional treatment if they care to do so.
Third, if you can get past the headlines and the screaming, you see that the word "routine" is really important. The doctor's decision -- in consultation with the patient -- determines whether a mammogram is necessary (and therefore covered under health insurance -- if the patient has health insurance, that is). This requires that doctors know more about their patients. It requires women to be knowledgeable about their history and honest about their behaviors (such as smoking). And it requires doctors and patients to discuss things in detail, which might take more than 5 minutes.
Funny, these are the things that people can agree on about what they want from health care, but here it is happening and everyone suddenly thinks it is a terrible idea.
Most of all, the sudden focus on mammograms should remind us how little attention we really pay to advancing women's health care. The current technology for mammograms was invented in 1986, more than 20 years ago. That's back in the dark ages, before cell phones could fit in your purse, let alone your pocket, and before you used e-mail. Yes, it was developed sometime after Atari and Commodore 64s, but let's be serious. Mammograms are not the most effective form of detection -- but, like sheep, we have gone for years to be squeezed in a vise and prodded and biopsied and tested... and we never stopped to question why there hasn't been a cost-effective technological advance in years for this basic screening process. MRIs and ultrasound together are much more effective, but costly. Here's basic supply and demand in action. There is no demand for a better product because we have blindly accepted that mammogram is the only option.
My family has dense breast tissue. We have fibroids. I don't want to have the invasive biopsy that my mom had -- which turned out to be a cyst, by the way. I want something better. I want something more effective.
I don't discount the fact that many women are living today because of early detection through mammograms, but I believe that there is something better out there. The market has been distorted by attachment to an ineffective technology.
If you feel you're at risk, talk to your doctor; demand a mammogram if that's what you want. Be prepared to pay for it if it's important to you. But more important, advocate for the development and deployment of technological advances that can save women's lives. We deserve better.
You are making the case for why profit should be taken out of the health care equation. We have an independent science panel that has looked at the data and found more mammograms do more harm than good between the radiation and the treatments and disfigurement. Cost isn't even what they were evaluating, they are just looking at the science. In the cold light of reality, an insurance company could defend a policy of dropping this very expensive benefit. But the public is outraged and there is no way any politician who wants to get re-elected would get anywhere near changing that benefit.
If mammograms are inaccurate, ineffective and potentially harmful as she says, then it's time for women to insist on better options. When it comes to health care, more than any area of life, advancements in technology should be quickly incorporated into services.
However, self-screening is probably the most effective way to detect breast cancer early. Manfre does not mention self-exams, probably because they do not reflect modern medicine. Yet knowing what feels normal, and then noticing a change in one's own breast is always going to be a vital detection method, no matter how advanced medicine becomes.
Given that many cases of breast cancer happen in women under 50, I also agree its not a good idea to postpone all cancer-screening efforts until that age. Whatever the technology may be, under whatever health care system is in place, women deserve screenings at reasonable intervals to catch cancer before it's too late. The definition of "reasonable" is a tricky one, of course.
More data, please?
Fair enough. But surely you’d concede that breast cancer is not the only type of cancer where early detection matters, right? And the rare young victims of other types deserve subsidized screening as well, right? With the same 99:1 value ratio, would you be willing to pay an extra $1 for early screening of bone cancer? Brain cancer? Lung cancer?
How about cancers of the cervix, colon, esophagus, eye, kidney, larynx, liver, mouth, ovary, pancreas, prostate, small intestine, heart, stomach, testis, thyroid, bladder, vulva, or anus? How about leukemia, lymphoma, myeloma, or melanoma? Would you pay an extra $1 out of each paycheck for every one of them? How about for hundreds of other chronic diseases? Are you willing to give up your whole paycheck and surrender your standard of living to save just one more life?
It’s not an easy call. But eventually making decent, affordable healthcare a reality is going to involve making tough decisions that don’t always make us feel good about ourselves.
Many here apparently believe that women have a right to subsidized annual mammograms starting at age 40. Despite the large body of evidence showing that starting at 40 instead of 50 and doing in annually instead of biennially requires an enormous additional expenditure of healthcare resources for very little additional reduction in mortality, I assume you’d say, “Who cares? No matter what it costs to save just 1 more life, it’s worth it.”
What if paying for this plan required you to pay an extra $1 in taxes out of every paycheck, and moreover that 99 cents out of that $1 was going to overhead like unneeded additional imaging and biopsies for the massive increase in false-positives, or treating cancers actually caused by 10 extra years of radiation to the breasts; and only 1 cent went towards saving the 1 woman out of 1904 who otherwise would have been missed. Probably still call that a no-brainer, huh?
Also, I found out yesterday that in Europe these same recommendations have been in place for 10 years and guess what? Europe doesn't have higher breast cancer death rates. Here's an article from Dr. Dixie Mills at the Women to Women Clinic and her reaction to the new recommendations. What I like about this article is that it stays focused on health -- and leaves politics out of the picture. Hope this links -- http://bit.ly/3Wl9gf What — no annual mammogram screening? New recommendations for women
This will be impolitic to say, but the general tone of this debate really isn't all that different from debates going on in the criminal justice field over whether or not draconian sentencing guidelines like "three strikes and you're out", or years in prison for simple drug possession, are really justifiable.
One side of that debate points out that (1) the vast majority of convicts swept up in such sentences are non-violent and pose very low actual threat to public safety; and (2) the costs to society of incarcerating this population are astronomical, and could be spent far better elsewhere, like funding thousands of community programs that can actually reduce crime rates.
The other side holds that as long as there is the most miniscule of threats to anyone, anywhere, at anytime, then any cost is justified to make sure that a fearful public can sleep at night. In fact, let's build more gated communities and make a fortune selling home security systems that make people feel good even if they don't measurably reduce crime.
The politics of paranoia rule this country. The number of conspiracy theories cropping up in these message boards is (anecdotal) evidence enough.
First...of COURSE there should be a better way to do a true test for early cancer than the squishing mammogram machines..AND..I now demand DIGITAL (still squishes..but much more accurate). I "missed" my annual mammogram (I was not high risk..no family history, etc)...in 2007...in March, 2008..I literally woke up...and showered..and SAW a 4 inch tubular growth across my SMALL chest...4 friggin inches...its size and how it showed up overnight...really made me feel it had to be scar tissue from a head on collission years earlier...but..I got my mammogram..then the dour look of the radioligist..saying a biospsy was needed
..then the call from my ob-gyn (she was shocked)...cancer...Tumor, Grade 3 (there is no higher grade)., stage IIB...brilliant surgeon, world famous had to operate TWICE to get clean margins...then..OMG...8 chemo cycles (ACT....pretty darn toxic) and 30 radiation...I HAVE to contemplate.."if" I'd gotten that mammogram in 2007...would it have shown a small lump...my guess...yes. Now..I want someone to explain, since the technology is THERE..why sonograms aren't used instead...many claim "cost"..but..say..a sonogram EVERY other year....(unless high risk)...oh..and ladies...don't think..that insurance companies will soon be able to deny coverage "if" you have a family history...(unless WE LEGISLATE)... I try not to be bitter..but the "what if"....never goes away...and my cancer, triple negative, high change of recurrance...and I've decided NOT to go through the whole thing again (ask me again in 5 years..just not today)...computers are cheaper than they were 20 years ago...there is no believe reason to think mammograms are MORE expensive today...
My wife had her mammogram in late 2003. The results were good, no signs of anything to worry about. I was on a remote tour came home early summer and noticed her energy level was very low. She and I both thought it had to do with 3 teenagers and running the house by herself. We visited our families during my leave and she commented how her mother had more energy than she.
I returned from my remote in November 2004. First thing I noticed was her right nipple no longer got erect and seemed to be retracting. I didn't comment for a good 2 weeks thinking it was a symptom of menopause (I know pretty stupid of me). Finally I told her and she said she had noticed it too and was going to get it checked.
January 05 her physician took a look and she had another mammogram. He said she had cancer. A core biopsy was taken a few days later which confirmed his diagnosis.
Studying your own body and checking for changes is probably the best disease finder. She had a fast growing cancer; luckily she responded well to the chemo, the sentinel node biopsy found it had spread to her lymph nodes, the surgery went well (double mastectomy followed by reconstruction) and she was given Herceptin for 15 months to prevent a recurrence.
She just got the okay from her oncologist he doesn't need to see her but once a year.
I'm reminded of someone reporting that the number of medical procedures done in an area often has less to do with the frequency of need and more with the number of specialists. Some areas had a spike in appendix operations, some had a spike in root canals, some had a lot of hysterectomies, or full-body CT scans. What may have pushed the annual mamogram may simply be doctors having to pay for the equipment!
I take issue with that statement. I'm pretty certain women's health care gets a great deal of attention and money. I know that women account for more than 50% of medical costs in the US so, at least by that financial measure, women get plenty of health care attention.
In popular culture, women's health issues get far more attention than men's do. Just last month, everyone in my office was walking around with pink ribbons to show that they had donated money to fight breast cancer. Every year the city of Philadelphia dyes its fountains pink to show their solidarity with people suffering from breast cancer. Every city I've ever lived in hosted walk-a-thons to raise money to research cures for breast cancer. By contrast, I've never heard of someone holding a walk-a-thon to raise money to fight prostate cancer.
I'm not saying women's health care issues get too much attention at the expense of men's health care issues. I think men tend to be a little more private about health issues, while women prefer seeking the comfort of friends and fellow sufferers. I just think its unfair to complain that women's health care gets "little attention." It gets a lot.
I would also like to see someone do a detailed story on this panel, both as to who it answers to and who its memembers are. The less covered recommendation to stop teaching women to do self examinations is inexplicable, and smacks of the conservative horror at anything to do with breasts.
I know everyone here hates the heritage foundation, but I'll post the link anyway. It explains the issue quite clearly.
http://www.heritage.org/Research/HealthCare/wm2505.cfm