OT/ Gov. report on Breast Cancer Screening

[roster]

I just talked to another female friend who added something to my knowledge, without bringing me to a firm opinion on what routine testing should be done. She first described, in a way I cannot, what happens in the many "false alarms" from mammograms. The patient and family often experience mental anguish. In addition the patients go through additional mammograms and finally biopsies. All incovenient and costly at least, and painful and damaging in the worse cases.

When the initial mammogram indicates a problem, there are at least five possible outcomes;

-A false positive.
-A slow growing cancer that would be as easily treated at age 50 as age 40.
-A cancer that would regress if left alone.
-An agressive cancer that will kill the patient quickly despite early detection and advanced treatment.
-Cancer that is treatable because it was detected early.

Of course, we all agree that item five needs to be addressed. So is the question what to do about items 1 - 4?

There is still something here about an individual being able to decide their own case to undergo mammograpy. But if patients want someone else to pay, then the patients need to realize that someone else is going to have a say in what they pay for.

[roster]

My above statements are not meant to be political. I don't have a position.

A classic political statement.

[macmermaid]

Unfortunately, I think where this is going is that any "public plan" won't include free mammograms. But what should a basic "public plan" include? That is the question.

[roster]

But what should a basic "public plan" include? That is the question.

The bigger question is, "Who will decide?"

I always say, let individuals make their own individual decision.

[Muse-Inc]

A public plan would likely require all women to have mammograms, something I do not want, on the grounds that early detection prevents costly treatment later. It would likely also mandate that all people with high BP take certain drugs or follow certain protocols in order to prevent more costly treatment later. It would likely require that all diabetics follow a certain protocol regardless of the cause (some drugs drive blood glucose into the diabetic range which disappears when the drug is stopped) which is nuts as there are several ways to manage blood sugars...easiest of which is to stop eating foods that turn into sugar in the body...of course that means dealing with the addictive aspects of carbs something that some are not prepared to do. I can only guess at the protocol they might dream up for us hoseheads .

[PST]

Unfortunately, I think where this is going is that any "public plan" won't include free mammograms. But what should a basic "public plan" include? That is the question.

I don't think there is any reason to expect that. The recommendations come from an independent panel of experts, called the U.S. Preventive Services Task Force, made up of primary care doctors and nurses. It has been around since the late 1980s issuing recommendations like this one on dozens of topics, although these don't usually get so much publicity. The members are not federal employees, and the staff work is done by contract with medical schools and similar institutions. For example, most of the work on the breast cancer screening study was done at Oregon Health & Science University. Its summary of the evidence is at http://www.ahrq.gov/clinic/uspstf09/bre ... rcanes.pdf. Not only does the Task Force have no connection with the current administration, its recommendations come with a disclaimer that they do not represent government policy. The members of the Task Force and the work on this project all go back long before the start of this administration. The question of whether screening should be recommended to all women at 40 or at 50 has been debated for many years and isn't related to the current health care finance debate. There is a consensus on the value of screening mammograms after age 50. This panel just says doctors shouldn't recommend them to every woman at 40 to 49. It says, "The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms." So I don't think the recommendation should be read as a prediction of what services will be covered by any public option that emerges (if one does) in healthcare finance legislation.

[jnk]

My above statements are not meant to be political. I don't have a position.

A classic political statement.

True.

I DO admit that I'm confused, which I believe may be a classic and very common state these days, politically and otherwise. Other than that, the only position I am aware of having, or that I am willing to go on the record with publicly in this discussion anyway, is that I am very pro-breast and very anti-cancer.

The wife gets screened every year although she ain't 50 and has no history that would point to a need for screening. Her tissue is so dense it is likely a total waste of time for everyone involved. But I believe she feels better getting it. Should she continue to do so? Heck if I know. Although I am her husband, I feel strongly that it is a decision strictly between her and her doctor. Will the bean-counters agree with that when that time comes up the next time? Who knows.

That is my relatively full disclosure.

jeff

[PST]

A public plan would likely require all women to have mammograms, something I do not want, on the grounds that early detection prevents costly treatment later. It would likely also mandate that all people with high BP take certain drugs or follow certain protocols in order to prevent more costly treatment later. It would likely require that all diabetics follow a certain protocol regardless of the cause (some drugs drive blood glucose into the diabetic range which disappears when the drug is stopped) which is nuts as there are several ways to manage blood sugars...easiest of which is to stop eating foods that turn into sugar in the body...of course that means dealing with the addictive aspects of carbs something that some are not prepared to do. I can only guess at the protocol they might dream up for us hoseheads .

What in the world would make you think something like that, Muse-Inc? The federal government already sponsors a bunch of insurance plans (Medicare, Medicaid, Tricare, etc.), none of which do anything of the sort. I have never heard of an insurance plan, public or private, that requires members to undergo painful testing or take any medication against their will. It's not in the House bill, and no variation of the proposed reforms discussed to date has included anything like that. No one would stand for it.

[Muse-Inc]

...I have never heard of an insurance plan, public or private, that requires members to undergo painful testing or take any medication against their will...

I haven't either BUT I believe they will slip something in at the last min. I believe this is akin to the medicare prescription plan fiasco which turned out to be a boondoggle for the ins companies. Now that said, I believe that the profit-driven insurance companies do not belong in any aspect of healthcare; they suck out $ that could go to provide more service. We have the best and most expensive healthcare system in the world that is unfortunately unavailable to a significant portion of the populace who earn too much for public asst and not enough to buy ins or pay directly for healthcare, those whose medical conditions make 'em/us uninsurable at any reasonable rate, and those who are laidoff and whose period of unemployment outlives COBRA or their State's miniCOBRA. I believe that the only way we will get congress to use whatever functional brain cells they have to create legislation that makes sense is to require that all legislative, excutive, and judical branch employees and their immediate and extended families are the first to become members of the new plan and no opting out of the system by using the congressional office doctor or trips to walter reed...well, maybe to keep the prez him/herself healthy. They'll be no creating a plan for those 'others,' it'll apply to them and their loved ones first.

[elg5cats]

The new guidelines are equally concerning as the allegations of over screening women creates a statistical insignificant number of diagnosed breast cancers to be treated...Current statement women ages 50-60's benefit greatest from mammograms......then adds recommendation to reduce the frequency of mammograms in this age group from yearly to every two year screenings. Logic, where?????

If I, my sister, my colleague, my neighbor, my friend and even my enemy becomes one of the statistical insignificant breast cancer numbers missed because we stop screening under age 50, only screen every 2 years in the highest risk group.......how does it become acceptable to sacrifice some for the "greater good." Who volunteers or is the draft for breast cancer sacrifice?

Screening recommendations have already shifted. First screening recommendation for me was age 35. I saw that age move to 40 and now headed to 50. I'm in the group alleged to be the greatest beneficary of mammograms. Am I now to shift to less frequent screening and be reassured by the new way to screen, reduce waste and unnecessary anxiety? Do I get to vote???? or simply watch as my insurance refuses to pay for annual screening and my health care provider follows the reimbursement guidelines rather than my health needs?

My college roommate was diagnosed with breast cancer 1 year after her graduation. She did not reach the age of 25 before diagnosis? What if mammogram had been available to her?

elg5cats

[macmermaid]

Unfortunately, I think where this is going is that any "public plan" won't include free mammograms. But what should a basic "public plan" include? That is the question.

I don't think there is any reason to expect that. The recommendations come from an independent panel of experts, called the .. Preventive Services Task Force, made up of primary care doctors and nurses. It has been around since the late 1980s issuing recommendations like this one on dozens of topics, although these don't usually get so much publicity. The members are not federal employees, and the staff work is done by contract with medical schools and similar institutions. For example, most of the work on the breast cancer screening study was done at Oregon Health & Science University. ...s of the Task Force and the work on this project all go back long before the start of this administration. The question of whether screening should be recommended to all women at 40 or at 50 has been debated for many years and isn't related to the current health care finance debate. There is a consensus on the value of screening mammograms after age 50. This panel just says doctors shouldn't recommend them to every woman at 40 to 49. It says, "The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms." So I don't think the recommendation should be read as a prediction of what services will be covered by any public option that emerges (if one does) in healthcare finance legislation.

I didn't mean to suggest that this is a politically motivated panel. Although it doesn't "represent" government policy, might it be used as a significant input to govt policy? Or not - I'm really curious.

[thewetlizard]

I don't believe in mammograms. That's why I won't get my boobies smooshed.

[PST]

I didn't mean to suggest that this is a politically motivated panel. Although it doesn't "represent" government policy, might it be used as a significant input to govt policy? Or not - I'm really curious.

That's a perfectly reasonable question. Sorry if I sounded like I was jumping down your throat there. (I've been a little over excitable since the "death panel" accusations started.) The House bill requires the public option plan to meet the same benefit standards as private plans qualifying for the national health insurance exchange. One of the requirements is that there be no required cost sharing for preventive services. So I don't think there is any reason to worry about coverage for mammography. Even if the task force recommendations become the consensus in the future, which is far from the case now, all they seem to be saying is that doctors should recommend mammography on a case-by-case basis before age 50, and only recommend it universally after age 50.

[TrueBlue]

I don't believe breast checks are a waste of time - quite the opposite. I found a lump at age 42 (13 years ago) which turned out to be malignant and necessitated 6 months chemo & 6 months radiology. Point is if I hadn't found the lump it would have got bigger and by the time it was finally detected it may have been too late. I know the false positive thing could be stressful but if it is cancer the earlier it's treated the better the outlook and the easier the treatment. I had to have the chemo because one of my lymph glands was affected - I often wondered if I'd found that lump sooner whether I might have avoided the chemo. I have monthly breast checks now and mammograms every 2 years. My surgeon at the time was an older man who made the comment to me that when he was a young intern the breast lumps he saw were often much larger simply because women were less aware and left it too long before seeking help.

[estherz]

First of all, not much has been mentioned in this thread about family history. I have been getting screened since age 40. Mammography once a year, ultrasound twice a year.. Had a baseline mammography at age 35. My mother and grandmother had breat cancer in the past. My sister age 48 was just diagnosed with stage 0 breast cancer (contained in the breast duct). If she had waited till she was 50- who knows what could have happened.

As far as not having the breast cancer gene... even if you don't have it you can still get cancer. I don't know if my sister has the gene or not, but I don't nor does my first cousin. We are still doing yearly checks.

Tumors disappearing??? I certainly wouldn't be able to live day by day knowing I have a tumor and not doing anything about it. I always thought cysts go away by themselves tumors not.

People with no family history, I think should check yearly after age 50. Because this type of cancer can spread quickly. But if someone is more concerned about the radiation that is their decision to make. Mammographys can miss something but together with ultrasound chances are better to see something if it is there.

Of course this is my opinion and stories that have happened to me. but I think it is important to know. Every case is different. But as far as people with family history do the tests on a regular basis, you never know.