By: Erin Lieber
This week some very surprising new breast cancer guidelines were released, through the U.S. Preventive Services Task Force. The group, made up of independent clinical experts , has amended their 2002 recommendation and gone against the early prevention guidance of the American Cancer society, which previously advised that woman should receive routine mammograms every 1-2 years after the age of 40. The new guidelines assert that women no longer need to begin the proactive mammograms at 40, but rather 10 years later, at the age of 50. What is even more surprising is that the Task Force disputes the effectiveness of self-examinations as well.
The reasons cited for the changes? Women in their 40’s are more likely to get false positive results leading to biopsies and stress. According to the Task Force, the benefits of early detection, in this age group, outweigh the risks of incorrect test results and the damage and cost of biopsies that are not necessary.
“The benefits are less and the harms are greater when screening starts in the 40s,” said Dr. Diana Petitti, vice chairwoman of the panel.
I have many concerns about the new guidelines. The first being, the precedent of ambiguity that is being set here. Whether or not it is their intention, these new guidelines contradict what so many have worked to instill in women: “Early Detection Saves Lives”. According to the U.S. Cancer Society, approximately 65% of women in their 40’s currently get a preventive mammogram every 1-2 years. Even with the old guidelines, only three quarters of woman followed the advice. Can we afford to have less than 65% of women seeing their doctors about breast cancer and getting the appropriate tests because of this new messaging? Doesn’t this go against all of the progress made by breast cancer survivors and cancer groups who have worked so hard to educate women on prevention and awareness? These new guidelines certainly don’t apply to those women who are high risk for breast cancer and have a family history of the disease, however, all woman are at risk for breast cancer. My fear is that these guidelines are inconsistent with the message that needs to be conveyed to woman on the importance of early detection, and I’m not the only one who sees this as an issue:
“Our concern is that as a result of that confusion, women may elect not to get screened at all. And that, to me, would be a serious problem,” said Dr. Len Lichtenfeld, the Cancer Society’s deputy chief medical officer.
Furthermore, what will these kinds of recommendations due for coverage of mammograms assuming that women within this age bracket still want to practice early detection? Will insurance companies change their policies and reimburse less or not at all for preventive mammograms within this age group?
Susan G. Komen for the Cure, the Dallas-based breast cancer advocacy group, said it won’t change its recommendation that women ages 40 to 49 get annual mammograms. “We would not want to see a change in policy or reimbursement for screening mammography at this time,” said Eric Winer, the group’s chief scientific adviser, in a statement.
What is motivating these changes? Is it more than just policy review and data extrapolated from studies over the last few years? Could this be the start of health care rationing as we see Congress and their constituents struggle with the cost of the new health care bill and insuring almost 40 million new members without a significant increase in health care workers and supplies? Will we see more of these kinds of guidelines ahead and efforts to decrease prevention as a government option unfolds in health care reform? The latest bill passed by the House included billions in tax increases without measures to control costs. Will we have to pay for health care reform at the expense of the very thing we should be trying to improve…will reform be at the cost of our health?
November 17th, 2009 at 8:39 pm
One more way that the Gov is showing us and warning us NOT to allow Gov run healthcare. If we allow it this will be nothing compared to what they decide on…and then regulate
November 18th, 2009 at 9:39 am
This is crazy. If one can diagnose and treat early, the less long term costs will be needed. Government needs to stay out of healthcare.
November 19th, 2009 at 6:44 am
Two separate issues can get confused here. One is government payments and cost cutting in general. Preventative health is often first to face the chop because the payback is tears in the future.
The second is screening. This has achieved saintly status for its ability to “save lives”.What does not get much media time are the people who have had unnecessary additional tests unnecessary treatments and additional stress due to either a false positive result or the finding of something that may have resolved itself.
The mantra “if just one life is saved” sounds good but screening is not as simple as that.
In Australia the recommendations for mammograms have been 2 yearly starting at age 50 for many years.Outcomes in Australia are not different to the USA
November 19th, 2009 at 6:58 am
Hi Dr. Joe. I think those are excellent issues you have pointed out. Funding for preventive services can be very tricky, whether public or private, as there are so many circumstances to weigh and there isn’t an infinite amount of money, which of course leads to difficult choices. I think both unnecessary screenings as well as the cited increased incidence of false positives in this age group, both deserve thoughtful consideration in the media and when we try to think logically about how these guidelines are formed. I am concerned though, about the ambiguity in the message that this sends to women regarding breast cancer, and that this could lead to more women not getting screening or talking to their doctors at about what they should do.
November 19th, 2009 at 7:56 am
More people need to hear what you have to say. Keep up the good work Erin.
November 19th, 2009 at 7:59 am
Hello,
Thank you! I would now go on this blog every day!
BernieR
November 20th, 2009 at 11:45 am
I can accept that perhaps a large percentage of women will not need breast cancer screening until they are a little older. I can also accept the harm a false positive causes and the costs that are ensued through unneccesary tests and procedures. However, women with a hisory of breast cancer in their family should not wait until 50 to start getting annual mamograms. Furthermore, I certainly would hate to see women neglect what could be symptoms of breast cancer by telling themselves that, “Hey, I’m not 50 yet. It probably isn’t breast cancer”. Many people lose sisters, mothers, aunts and so on every year to this insidious disease. The last thing this country needs is an “uneducation” session on breast cancer. Keeping it on the tips of our tongues and preventative screening starting at 40 has made major headway over the years.
November 24th, 2009 at 12:06 pm
Dr Joe is somewhat correct. The first issue raised is precisely the reason that we should not allow our government to control our health care access. Our elected officials who were charged to protecting our nations interest have failed miserably in carrying out their charged duties. They are on a wild spending spree that is going to bankrupt this nation. In the first 11 months of our junior presidents office, we have spent more money into programs that have zero accountability and have not contributed to the US economy as a whole. The fact of the matter is that when the government acts as both your judge and jury you are often the loser. The government want to pay for your healthcare and also controls the access. This is a recipe for disaster and as the old saying goes….an ounce of prevention is worth a pound of cure.
Stress and worry take a lot longer to kill than a tumor. The joy of a negative end result is worth the stress …isn’t it?
Is Dr Joe then saying not knowing what killed you should make you feel better? Is it fair to compare two very different populations?
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