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Mammograms and cost containment
18 Nov2009
If you love controversy then you love the discussion of breast cancer screening. We have known the data that suggests that screening woman under the age of 50 does more harm than good. An independent organization changed their recommendations this week - Panel Urges Mammograms at 50, Not 40
The United States Preventive Services Task Force probably does the best job of objectively evaluating evidence about prevention. Their report passed rigorous peer review.
But will physicians and patients follow these "guidelines"? Many Doctors to Stay Course on Breast Exams for Now
This controversy is not about the data, but rather the interpretation. Readers know that I have written often about the importance of perspective in developing guidelines. The American Cancer Society see this issue differently.
The politics of these guidelines are impossible to overstate. These guidelines change a paradigm that most women embrace.
We can never contain costs in this country if we are not willing to make cost based decisions. While these guidelines do not address costs, this really is a cost issue. We likely create more disease through screening then we find. We likely do more harm and spend inordinate moneys. But when you talk about breast cancer, we cannot have an objective discussion.
We want to decrease the rising health care expense of this country. It will require difficult choices. Americans may not be ready to make such choices – unless they must pay "out of pocket".
Related posts:
- Politics and mammograms – I am disgusted and disappointed
- Not all screening helps patients
- My disappointment in Sebelius
- Prostate cancer screening
- Keep politics out of medical decision making
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- In: Medical Rants
4 Responses to Mammograms and cost containment
boblaker
November 18th, 2009 at 9:51 am
Spot on. And Jonah Lehrer over at his Frontal Cortex Blog has an excellent piece comparing screening mammogram decision making with Bill Bellichick's fourth down decision.
http://tinyurl.com/y9hwkuv
Ed Whitney
November 18th, 2009 at 10:22 am
Anyone have a sense of deja vu with these guidelines? In 1996 and 1997, the NCI came to similar conclusions about screening mammography. An editorial (Am J Public Health 1997 87: 1103-1106) showed the political response to the NIH Consensus Development Conference. Time to replay the theme with 2009 variations (Obamacare, death panels, government control of health care, etc).
Michael Kirsch, M.D.
November 18th, 2009 at 12:22 pm
I share the 'ranter's' skepticism of guidelines, often conceived and promulgated by academics (sorry Rob!) in some rarefied conference room. However, the USPSTF is highly regarded for its objectivity and conservative approach to medical care. It took guts to issue their new guidelines, which contradict their own guidelines on the same subject several years ago. The value of preventive care – including my own beloved colonosopy procedure – is overrated. I am sure that most ordinary folks, and even some physicians, would be quite surprised how modest the medical benefits of mammography are. Although I support the test, they provide very limited protection for women. To those who argue that it is worth all of the money, radiation, anxiety and false postive results if it will save even a few lives, would you support lowering the speed limit on our highways to 40 mph? http://www.MDWhistleblower.blogspot.com
Ed Whitney
November 19th, 2009 at 12:15 pm
The Secretary of HHS has been backing away from the USPSTF as fast as she can backpedal. This is a test of the Obama administration commitment to comparative effectiveness research.
The political rhetoric has heated up as the USPSTF members, who were only "idiots" two days ago, are now "murderers." The replay of the 1997 drama, with adjustments appropriate for the age of Sarah Palin, is proceeding about on schedule.