Is Womens' Health Care Under Attack?

[BirminghamExaminer]

Please read the entire editorial here. I pared the article down as much as I could here so you get the gist.

Women pay approximately 48% more for health care than do men in the United States. Even after paying high health care premiums to health insurance companies, women are sometimes denied coverage of pregnancy and childbirth care because it is deemed a pre-existing condition.

In the latest form of the health care reform bill, Bart Stupak, (D), MI., proposed an amendment that would exclude abortion care and treatment from health insurance for women, not just government funded health care such as Medicare or a public option but by any private health care insurance company as well. The Stupak amendment passed and if it isn't cut from the bill, women will find themselves with few choices.

Coming just days after the Stupak amendment was voted on and passed, a private sector task force commissioned by the Health and Human Services division of the U.S. government announced that it would recommend that physicians forego advising female patients under the age of 50 to have annual screening for breast cancer. The U.S. Preventative Service Task Force (USPSTF) panel of 16 included three private health insurance company representatives but no oncologists. The panel measured some number models and came up with the recommendation, ostensibly because of a higher number of 'false positives' among women under 50, causing anxiety and sometimes, unnecessary followups and testing.

It's widely known that the United States ranks far below other developed nations in health care costs, treatment results, and lifespan but one of the few areas in which the U.S. has excelled has been in preventing cancer deaths. It is unclear why the USPSTF has recommended suspension of annual mammograms for women under 50.

According to the Washington Post, "Many experts have begun to raise questions about routine screening methods, including the PSA blood test for prostate cancer and mammography, because they often trigger false alarms and catch precancerous growths and tiny tumors that would never become life-threatening but nonetheless prompt treatment."

But so far, the USPSTF hasn't recommended suspending testing for prostate cancer in men under the age of 75.

In August of 2008, the USPSTF made recommendations regarding prostate cancer screening that is very different than its recommendations for breast cancer screening.

So in 2008, the USPSTF in essence, recommends that physicians discuss the benefits and risks of prostate cancer screening with their male patients under the age of 75 and decide what action to take, if any.

Both prostate cancer and breast cancer screening effectiveness has been controversial in the last decade but the USPSTF appears to believe that physicians and their male patients can discuss the controversy and come to a decision about whether or not to be tested and how to be treated. Yet their recommendations that physicians forego recommending any sort of breast cancer screening to their female patients seem to indicate that the 15% of women between 40-49 whose deaths are prevented by screening aren't worth the bother of having to explain what the options, benefits and risks of breast cancer screening are to women.

[valleywine]

1. I have worked in health care

all mhy adult life. I can not immagine stopping education for breast self exams. It is part of my life and for many also. I just shake my head.



The USPSTF panel recommends that women don't need to perform breast self-examinations as part of their routine but the National Breast Cancer Foundation disagrees. Founder Janelle Hall discovered a lump in her breast at the age of 34 through self-examination and a mammogram detected she had breast cancer. She writes on the NBCF website that she "would not be alive today" had she followed the recommendations made by the USPSTF.

Another breast cancer survivor, Representative Debbie Wasserman Schultz, (D), FL., spoke to Chris Matthews of Hardball on MSNBC about detecting a lump in her breast during a self-examination that led her to have a mammogram that detected cancer. She was in a higher risk group for the disease but wasn't aware of the risk until she was diagnosed.
....

[BirminghamExaminer]

3. Now another group is recommending limiting pap smear tests

http://abclocal.go.com/kgo/story?section=news/health&id=7129084

There's a link to the info. This just came out overnight.

[pleah]

2. K&R

[ananda]

4. YES

ABSOLUTELY.

And it's a crime.

[phantom power]

5. I was listening to NPR on this whole "risk/benefit" thing...

and I'm still trying to figure out if my ears aren't working, because I could swear that these people were actually saying the "risk" was "cost of test."

Before I slide off into a berzerker rant, is that what other people are hearing too, or is there some actual health risk to these breast exams and tests?

[Crabitha]

6. When did you hear that on NPR?

The mammograms are uncomfortable for some women. They also show false positives on occasion which may lead to a biopsy that *may* in some way disfigure ones' breast.

My sister-in-law was just diagnosed with breast cancer three weeks ago. She had two years of mammograms that showed something before they finally decided to do a biopsy that showed she had cancer. They had her coming in every six months so that was four exams that showed a "shadow". Finally when the shadow appeared larger they did the biopsy.

But I know someone else who had one exam that had a shadow on it and she asked her doctor to do a biopsy which they did and it was nothing serious.

It should be a woman's choice after talking with her physician. My concern is that the panel doesn't have a single oncologist on it but has 3 health insurance company representatives on it. I'm sure the next step will be that the insurance companies will quit paying for yearly mammograms.

[phantom power]

9. It was yesterday afternoon...

my wife has described how mammograms work, and it sounds excruciating. For example, I'm very very glad that I don't have to examine my testacles that way.

Last week when I heard that there were no oncologists on that task force, it was a HUGE RED FLAG. Seriously? You're going to publish an evaluation of breast exams with no input from oncologists?

In my opinion, that alone should completely discredit their conclusions. Bring in some oncologists, and do over, please.

[Recursion]

16. The task force is mostly public health / number crunching docs

They're supposed to set guidelines for just about all treatment by looking at what's been effective and what hasn't. The data told them that mammograms for women under 50 haven't been saving lives.

[BirminghamExaminer]

17. Look at the numbers, 15% of women 40-49 survive breast cancer

because of mammograms. That is a significant number. There were no oncologists on that panel. There were three insurance company representatives. It's not hard to figure out what is going on here.

This panel was created in 1984 under Reagan. It's a private sector panel retained by AHRQ under HHS and if this is the sort of thing they are coming out with, the panel needs to be dismantled.

They didn't recommend that doctors give up telling their male patients about the pros and cons of being tested for prostate cancer, instead, they recommended doctors talk to their male patients and come to a mutal agreement about whether or not to be tested and whether or not to seek treatment in the case that treatment is indicated.

But for women, as in breast cancer, the panel recommended that women quit doing self-examinations, having yearly mammograms, etc. It's reckless. They could easily have recommended that physicians speak with their female patients about the pros and cons of mammograms and self-examination (i.e., anxiety) and whether or not to have them or perform them but instead, to 'avoid anxiety' they recommend not starting mammograms until the age of 50. What about the 15% of women who are diagnosed and successfully treated thanks to mammograms? I say let my doctor and I decide whether or not I should have a mammogram. I'll deal with any anxiety. It's ridiculous.

[Recursion]

18. Except that's not true, as the task force described pretty painstakingly

If you're simply going to knee-jerk into saying "mammograms save lives", there's no real point in this. Increased rates of finding cancer are not leading to decreased mortality; the fact that someone believes her life was saved does not make it so.

[phantom power]

11. And another thing. There they were on the radio...

seriously pondering: "gosh, do you think maybe the insurance companies will use this as justification to stop paying for yearly breast exams, even for high-risk patients?"

There's only one right answer to that question, and you don't have to be a goddamned rocket scientist to figure it out. And yet the one guy they were interviewing was all "well this is science, and what we do with this information is in the realm of policy and politics. I hope we use this information responsibly." Wake up, fella.

[Recursion]

15. Whoever was on "On Point" was better than whoever was on "Diane Rehm"

The risk is about exposure to radiation in the mammography and side effects from biopsies. Neither of these are risk-free.

[alarimer]

19. The risk from unnecessary treatment is not zero.

There is a also a non-zero risk of exposure to radiation from the x-rays themselves. Given 10 more years of x-rays, that does lead to a number of cancers as a result of the radiation. It is a small number but it is NOT ZERO. Given those risks, the panel simply determined that the benefits of annual screening for women 40-49 are not worth the risks. Keep in mind that recommendation is only for women who do not have elevated risk factors, like close relatives with the disease. Those women still must be tested more often than everyone else.

These recommendations are sensible and right in line with recommendations for prostate cancer tests, for example. For similar reasons, they do not recommend annual screening except for men in high-risk groups. And yet no fuss was made about those when they came out a while back.

Unnecessary testing leads to over-diagnosis and over-treatment, both of which carry their own sets of risks.

We must look at this from a scientific point of view and not from an emotional one.

[mod mom]

7. Is it possible the insurance industry is behind this as a way to cut paying for these

procedures? If they are no longer rec'd then they can justify not reimbursing for them. Of course, the wealthy will have the means to continue having these procedures but for those who can't afford the extra costs, well they can rest assured that their insurance carriers are profitable to their shareholders. :mad:

[Crabitha]

8. if that happens it would be all about the numbers I think....

As in the risk of paying out to their clients who get cancer and must have treatment and will probably die because it wasn't detected early will probably cost less than paying for annual mammograms for everyone every year.

And what about the women over 75? They just quit doing them then. I wonder if that means nobody over 75 gets breast cancer or if they just don't care since they're old and are going to die sooner instead of later.

[Overseas]

14. It is more like private health insurance PR behind the stories.

They want to get the public riled up about RATIONING care. That's their big push right now. Get citizens to fear the prospect of HEALTH CARE RATIONING. You see, Mr. & Mrs. John Q. Public, you're gonna have to put up with horrible limits if you let the government run your health care.

What a coincidence that right after the mammogram limit story comes out, there's another one recommending slowing down pap smears.

Let's not think about the 45 million who can't get any preventative tests at all.

Let's not think about the same Republicans complaining about health care rationing with these recommendations being those who also voted against including annual mammograms and pap smears in health care reform bills.

[Crabitha]

10. I watched the video of Chris Matthews and Wasserman.....

Did anybody else cringe at the end of that video? I'm glad he interviewed her and is in favor of women having mammograms, etc., but the end of that interview was a little bit creepy.

[spiritual_gunfighter]

13. Most Chris Matthews interviews end up being a bit creepy n/t

[Jester Messiah]

12. I hate headlines like that.

There's no question about it. The headline should read "Womens' Health Care Under Attack."