LOS ANGELES (YBH.ME) – Health guidelines, recommended by statistics-reviewing committees and vetted by experts, are released several times a year, to little if any fanfare. Press releases about the number of calories you should eat in a day, vaccine schedules for tots, prostate screening efficacy, and so on hit the news wires and fade away.
Women Under 50: No More Mammograms?
Then there was yesterday’s uproar and dissembling, when the U.S. Preventive Services Task Force (USPSTF), announced that an exhaustive review of studies and stats showed there was little benefit to routine mammography screening in women prior to age 50.
The USPSTF is a peer review panel under the umbrella of the Agency for Healthcare Research and Quality. From their website:
USPSTF recommendations highlight the opportunities for improving delivery of effective services and have helped others in narrowing gaps in the provision of preventive care in different populations.
Translating the bureaucratese indicates that their goal is to raise awareness of the need to practice preventive medicine, and equalize access to prevention.
Hmm. The new recommendation certainly could equalize access, since an entire population group will be removed from the yearly mammogram pool. And thus those newly-available machines will be put to more efficient use, right? The American Cancer Society’s response was swift: yearly mammograms still recommended for women at age 40. Among other reasons, having a baseline mammogram to work from ensures better readings down the line should their be changes in the breast. Insurers are scrambling to make sure it’s clear they won’t drop mammogram reimbursement based on the panel’s recommendation. Well, not this year anyway.
Many believe that a heavyweight panel’s recommendation will eventually be incorporated into policy at every level. For government medical programs, that’s a given. And since we may all be on a government program soon, or at least a government approved one, it’s a-coming.
The panel did not find screening at 40 was of no help, just that there was not enough impact to be statistically significant. Of course, as with any medical decisions, that changes if you, your mom, daughter or sister are the statistic.
Dr. Carol Lee, chairwoman of the American College of Radiology Breast Imaging Commission, said in a statement “since the onset of regular mammogram screening in 1990, the death rate from breast cancer, which had been unchanged for the preceding 50 years, has decreased by 30 percent.” She went on to bluntly say that the guidelines seem intended to ration care.
The task force countered the uproar by stating that the false positives and negative biopsies resulting from the mammograms in women between 40 and 50 indicated they did not lead to death prevention as there was no cancer to address. By that logic, if it’s determined that most drivers not wearing a seat belt don’t have accidents, then seat belts don’t save lives.
The varying responses of the medical establishment to the new guidelines tend to fall, not along party lines, but very much on academic versus practicing doctor lines. The academics, removed from front line medical practice, smoothly eliminate tests to balance the books. Practitioners, who puts names and faces to charts, want their patients tested, reassured, and treated for cancer as early as possible.
A senior radiologist at Boston’s Massachusetts General Hospital, Dr. Daniel Kopans, stated in an interview with Reuters, “there were no new data to assess. One has to wonder why these new guidelines are being promulgated at a time when health care is under discussion and I am afraid their decision is related to saving money rather than saving lives.”
Laura spent years as a Hollywood story analyst, did a big 180, and is now an entrepreneur focused on web marketing and analytics. She's also a mom of one.Laura Glendinning article archive.
