Is this how the "government" hope to save healthcare costs, telling women not to have mamograms?

[still_one]

http://news.yahoo.com/s/ap/20091116/ap_on_he_me/us_med_mammogram_advice

"New advice: Skip mammograms in 40s, start at 50

NEW YORK – Most women don't need a mammogram in their 40s and should get one every two years starting at 50, a government task force said Monday. It's a major reversal that conflicts with the American Cancer Society's long-standing position.

Also, the task force said breast self-exams do no good and women shouldn't be taught to do them."

....

and self-exams do no good? gee, so if someone feels a lump they should ignore it? Is that the message they want to send. Are these the same people running the vacination program, or better yet, the bail out of the financial institutions.

So whose life is worth what, as one critic of the study eloquently responded"

"The new advice was sharply challenged by the cancer society.

"This is one screening test I recommend unequivocally, and would recommend to any woman 40 and over," the society's chief medical officer, Dr. Otis Brawley, said in a statement.

The task force advice is based on its conclusion that screening 1,300 women in their 50s to save one life is worth it, but that screening 1,900 women in their 40s to save a life is not, Brawley wrote.

That stance "is essentially telling women that mammography at age 40 to 49 saves lives, just not enough of them," he said. The cancer society feels the benefits outweigh the harms for women in both groups.

International guidelines also call for screening to start at age 50; the World Health Organization recommends the test every two years, Britain says every three years.

Breast cancer is the most common cancer and the second leading cause of cancer deaths in American women. More than 192,000 new cases and 40,000 deaths from the disease are expected in the U.S. this year.

Mammograms can find cancer early, and two-thirds of women over 40 report having had the test in the previous two years. But how much they cut the risk of dying of the disease, and at what cost in terms of unneeded biopsies, expense and worry, have been debated."

Between lobbyists writing speeches for Congress on healthcare reform to this, tell me why would I trust what the government says?

[Goldom]

1. It's not just that.

I just posted this in the LBN copy of this news, but look at
http://www.sciencebasedmedicine.org/?p=2249

Basic points - too early screenings can catch cancer-like things that have a fair chance of vanishing on their own, but having no idea which are which, all are treated, leading to unnecessary painful and expensive treatment for people who might not have needed it. Is avoiding that worth the opposing risks? Obviously from your news post, some say yes, some say no. But it's not just about money.

[still_one]

2. No one can determine if "cancer-like" things have a fair chance of vanishing on their own

I wonder if Andrew Lloyd Weber or Chris Dodd would like to wait and see if they disappear on their own

The question is how much harm is done with the diagnostic tests?

So if this policy is instituted where screenings a reduced for certain Demographic groups, and the rate of breast or prostate cancer deaths increases, what will they do then?

[Bitwit1234]

19. You are correct and also back in the 70's and 80's

doctors advised women not to have mammograms til they were in their 50's because of the risk. If they suspect something then a sonogram is not harmful and that should be done.

[sandnsea]

3. Ah, so now we oppose government run health care

and commissions that coordinate necessary health coverage in order to cut costs.

Note when it actually happens, people take a step back.

Yes this would happen with single payer too.

As to mammograms, my radiologist told me it was likely I would find a lump before a mammogram because of dense breasts. 1/3 of women have dense breasts. So maybe the task force methodology is faulty and comparing which women would benefit from what technology would be a better approach.

[still_one]

5. Funny, but they also recommend women shouldn't do self-examines either

I would like someone tell me the harm in a women doing a self-exam?

Oh, yes, they might find a lump. They may find the lump isn't cancer.

but they also might find that it is cancer

Let me watch the Doctors and Army stand in the Nevada dessert and receive radiation back blast, and tell the soldier that their is no danger

[sandnsea]

8. That is crazy - check this out

"You save more lives because breast cancer is more common, but you diagnose tumors in women who were destined to die of something else. The overdiagnosis increases in older women," Mandelblatt said.

Wow. That's just wild.

They don't always do biopsies either. I have a spot we're going to watch. Freaked me out at first because I thought I wasn't getting good care because there was no biopsy. But after doing a lot of reading, I decided watching it was fine. It's probably a bruise from my grandson jamming his elbow into me. But every woman should have a baseline in her early forties and a decision about follow-up made from there. I can't imagine the problem in doing breast exams either.

[still_one]

24. Where are they coming from, its insane /nt

[Cessna Invesco Palin]

4. Hmm... If my mother had followed that advice she might very well be dead now.

And my mom's sister IS dead because her breast cancer (which arose in her early 40s) was not detected in time.

[still_one]

6. and I know two people in their forties, who didn't have a history breast cancer in their family

who most likely wouldn't be here today if it wasn't detected early

Let them play with their families lives, not mine

[Ms. Toad]

9. On the other hand, they could not find my mother's

breast cancer on a mammogram with a needle pointing at it (EXTREMELY PAINFUL). It was invisible. She found her cancer (and several earlier lumps) with BSE. Wonder why I'm a few years late on my mammogram, even though both my mother and grandmother had/have breast cancer - but absolutely faithful in monthly BSE.

[Cessna Invesco Palin]

21. I see no reason why both mammograms and BSEs should not be encouraged.

Mammograms are not expensive procedures, and they save lives.

[Ms. Toad]

22. In our family's personal experience,

they (mammograms) do not save lives because they do not detect cancer. My understanding is that my family is not alone - and if this is the case then women may be gaining a false sense of security (and little motivation to perform routine BSE - which is how every woman I personally know of who has breast cancer has detected it).

[Cessna Invesco Palin]

47. Mammograms are certainly not infallible.

Nor are BSEs. However, both have the potential to detect breast cancer. This doesn't mean you should let down your guard, but not participating in BSEs and mammograms is certainly more risky than doing them.

[Ms. Toad]

48. I agree with respect to BSE - but not with respect to

mammograms. At least at earlier ages, mammograms may actually be more risky than not having them, for two reasons.

My mother had a tumor of around 5 cm, and it was invisible on the mammogram with a needle pointing right in the middle of it. I know enough about my family history to recognize that mammograms mean virtually nothing in our family. Many people for whom the same is true don't know that. They have routine mammograms, get a false sense of security, and all too often stop watching for other signs. In the alternative, when the mammogram does show something the treatment tends to be more aggressive and to subject the recipient to increased risk (and the risks of undergoing anesthesia are not insignificant) when there may well be no need for any treatment at all.

In my mind, ultrasounds (particularly in the earlier years) are like Megan's laws. Identifying the person who happened to get caught (typically after up to 100 offenses) does two things: (1) It gives neighbors a false sense of security that they know the source of all danger (the equivalent to thinking that everything is OK because the mammogram was clean) and (2) subjects the identified person - who may be no threat at all and who has paid his debt to society - to perhaps unfair scrutiny and abuse (the equivalent of undergoing unnecessary surgery because a spot looks suspicious).

While I agree with the new recommendations regarding mammograms, I do not agree with the recommendations regarding BSE, which relies on familiarity with your own personal breast tissue and noticing subtle changes - far more reliable than the ultrasound if done regularly, in my family's experience and my opinion.

[sandnsea]

51. It's about breast density

That's what my radiologist told me, and also told me I was more likely to find a lump than the mammogram because of it. I hope these are things most women are told, at least now even if not several years ago.

[Ms. Toad]

52. Mostly density - but not entirely.

Things don't show up any better on mine now post 18 months of nursing (much less dense) than they did when I had my first mammogram pre-child birth. In each case, I had an identifiable lump that both a physician and I could find, that felt unusual enough to both of us that he recommended it further evaluated. In the post-child birth mammogram, the lump did not show up on the mammogram, with an opaque marker placed on my breast so the location should have been clear.

The pre-nursing lump disappeared before a scheduled biopsy; the post-nursing lump was visible on an ultrasound but not the mammogram, and it was apparent from the ultrasound that it was not cancerous.

Mammograms are really just not terribly precise tools for finding lumps. They both miss lumps and return lots of false positives, not necessarily for predictable reasons. The high rate of false positives is a large part of the reason the recommendation is to delay routine mammograms for women at no particular risk for breast cancer - until the likelihood of finding cancer is statistically greater (i.e. more of the hits the mammograms make are true positives, so that unnecessary needle biopsies and lumpectomies are avoided).

[sandnsea]

53. Did you have a sonogram?

They sent me for a sonogram after the mammogram. There are also digital mammograms now. So there are methods to do further testing without using biopsies.

I don't completely disagree with less mammograms. But I do disagree about self exams and some kind of diagnostic regime.

[Ms. Toad]

54. We're in the same boat in thinking about the BSE.

recommendation. That thinking I don't understand - sort of like telling people not to be observant about their bodies. Hey - ya know those ABCs of watching for pre-cancerous moles - stop looking at those moles. We don't want you to pay any attention. :crazy:

I'll have to read that part of the recommendation more closely. I don't necessarily think that a rigid monthly schedule is required if it is somthing you regularly do. Mine tends to be far more frequent than monthly. I note changes, watch them for at least one cycle, and then if they are still troubling I head to the doc.

I had an ultrasound/sonogram after the lump that hung around for a while - it indicated it was nothing to worry about.

[Lance_Boyle]

49. the rate of false positives is too high

new technology is needed.

[Lars39]

7. And to not even recommend self-exam?! They're full of shit.

[Ms. Toad]

11. Although I agree with them on the mammography,

I agree with you on the BSE.

[corpseratemedia]

10. my mother would have been dead

it was a tiny little spec on a mammogram, could have been ignored. When it was biopsied, there was an agressive cancer encased within a non-agressive cancer.

my mother had a recurrance several years later. Again, looked like a tiny speck. A speck that had spread through her body that time.

Sorry but they should not be ignoring anything (and women now get digital mammograms). so what they'll only know once it's biopsied. My mother and lots of others are alive because of "unneeded biopsies."

Just spend some of that endless-war-with-never-a-chance-of-winning money on healthcare.

[TicketyBoo]

12. You know…

I've thought about the possible increased risk of breast cancer due to too-frequent mammograms. Probably the increased risk is small, but not non-existent.

I don't see this as a big deal. I think I had my first (and last mammogram) when I was 38. The doctor termed it a "baseline" mammogram. That was 20 years ago.

I see no harm in self-exams, but it could be that most women who find something are freaking out about something which turns out not to be cancer. In that case, it isn't just a case of unnecessary treatment, but also unnecessary anxiety.

Of course, anyone with a family history is going to want to be more alert, and the stories I've seen don't suggest anything less than vigilance for those women.

[ohheckyeah]

15. But that's the problem

"probably". Sonograms could be used and are known to be safer than mammograms. BUT, sonograms are more time consuming and thus more expensive. I had a doctor to refuse to order ultrasound instead of a mammogram even though I was going to pay for it. Come to find out the doc had a financial interest in the company that did the mammograms.

[ecstatic]

13. I don't think there's a perfect answer to our healthcare problems

People want costs cut--but then when people try to cut costs there is a backlash. This article also foreshadows potential problems with a fully government run healthcare system. Honestly, none of those issues would bother me because in my mind I understand that costs have to be cut, etc., but I can envision a lot of DUers who complain about large costs, less government options shouting the loudest about these types of studies.

[noiretextatique]

14. MRI More Effective in Detecting Ductal Carcinoma In-Situ (DCIS) Breast Cancer than Mammography

Researchers from Germany have reported that MRI (magnetic resonance imaging) detects almost twice as many DCIS as mammography and is especially effective for detecting high-grade DCIS. The details of this study appeared in the August, 2007 issue of Lancet Oncology.<1> This data was also presented at the 2007 meeting of the American Society of Clinical Oncology (see first item of related news).

The goal of cancer screening is to detect cancer at an early stage, when treatment will be most successful. For the early detection of breast cancer, the American Cancer Society recommends an annual mammogram and clinical breast exam starting at the age of 40. In addition to mammography, women at high-risk of breast cancer are advised to receive annual screening with breast MRI. Although MRI has been reported to detect more breast cancers than mammography, it is also much more expensive and more likely to produce false-positive test results. Although it has been demonstrated that MRI is more sensitive than mammography in detecting invasive breast cancers, MRI's ability to detect DCIS has been doubted since this technique does not detect calcium.

The authors of this study compared 7,319 women who had both a mammogram and an MRI. They found that 193 women had surgically documented DCIS. Of these, 167 occurred in women who had a preoperative mammogram and an MRI.

MRI detected 92% of the DCIS cases and mammography detected 56% of the cases.
48% of high-grade DCIS were missed by mammography and all were detected by MRI.
There were 2 cases missed by MRI that were detected by mammography and both were low-grade.
One explanation for these findings is that many DCIS cases do not contain calcium and would not be detected by mammography. The reason given for the effectiveness of MRI is that with contrast there is better visualization of neovascularization that occurs with DCIS.

Comments: This study suggests that MRI may be better than mammography at detecting DCIS—particularly high-grade DCIS. It should be noted, however, that this study was performed at a highly-specialized center with extensive experience with MRI. An accompanying editorial stated that “These findings can only lead to the conclusion that MRI outperforms mammography in tumour detection and diagnosis. MRI should thus no longer be regarded as an adjunct to mammography but as a distinct method to detect breast cancer in its earliest stage. A large multicentre breast screening trial with MRI in the general population is essential.”<2>

http://professional.cancerconsultants.com/oncology_main_news.aspx?id=40348

of course, my insurance company won't pay for another MRI, even though i had an invasive form of breast cancer :eyes:

[Berry Cool]

16. And you know what? In situ is pretty much the best kind of breast cancer to have

because it hasn't invaded tissue, definitely hasn't spread, and can be treated very successfully.

In fact, there's question as to whether it needs treatment at all. So are we really gaining anything by detecting it earlier, when it may never really pose any danger at all?

This is the problem. "Early detection" detects EVERYTHING--aggressive tumors that will kill no matter how soon they are found, small tumors that can be stopped early, thus saving a life, and tumors that will ultimately never do any harm at all but will be removed at much expense and trouble.

Mammograms also expose the breasts repeatedly to radiation. It's risky; it just is.

And BSE can also detect stuff that will ultimately never do any harm. We just don't know.

The long and the short of it is, we need a better method of detection than mammograms OR BSE...but what we need most is prevention.

Early detection just provides more treatment options. It doesn't guarantee a life will be saved. Only prevention and/or cure does that.

[noiretextatique]

27. i had in situ and invasive

but thankfully the fairly slow-growing tumor was still contained in the breast. i had a lumpectomy/radiation and i get mammorgrams every six months...since nov 2007. i had one breast mri, and my breast doctor told me the FUCKING INSURANCE COMPANY WON'T PAY for breast mris. mammograms are still painful and i am being exposed to more radition :argh: i am going to take on this fight for breast cancer survivors.

[Contrary1]

32. Thank you. We need all the help we can get. n/t

[Cleita]

34. Find a clinic that does digital mammograms. No more radiation. n/t

[noiretextatique]

40. do they have to squeeze the breast?

my breast is still tender.

[Cleita]

44. Unfortunately they still do. I just had one a few months ago.

Ouch!!

[Hangingon]

26. My wife is completing treatment for DCIS at MD Anderson now,

She had a mammogram in February that was clear. Then 5 weeks later she detected a problem in a routine self exam. MRI and biopsy confirmed DCIS. We have been thru chemo, a mastectomy and are starting radiation. The MDA oncologist has already scheduled a mammorgam for February and urged regular self exams. The story I read this morning didn't identify any oncologists only. Think I will trust MDA.

[noiretextatique]

30. she had to do chemo for DCIS?

i had DCIS and invasive ductal carcinoma, and i didn't have to do chemo. her tumor must have been very large, or fast-growing. after chemo, radiation is a breeze. just make sure she slathers herself in aquaphor and cornstarch to lessen the skin irritation. :hug: been there, with myself and several friends :hug: :hug: give that one to your wife for me.

[treestar]

17. There were specifically saying they were not needed

One can disagree with that without making up negative motives.

[alarimer]

18. No, there have been a number of studies suggesting they do not do a whole lot of good.

Too many tests leads to overtreatment. There are false positives, which leads to more invasive treatments for no reason (and more expense). The number of additional people saved due to increased mammograms is not very great, considering the added costs. Not to mention the extra radiation, which may not be good either. It is not a conspiracy, but actually SCIENCE, refining the requirements.

This is how science works, for you scientifically illiterate idiots (almost everyone on this website) out there. It is not a conspiracy by the government to keep costs down.

Part of the reason our health care costs are too high is that doctors ORDER TOO MANY TESTS, often because their stupid, scientifically ignorant patients have requested it or they are practicing defensive medicine.

[still_one]

25. I am sure that Andrew Lloyd Weber or Chris Dodd are happy they practiced defensive medicine /nt

[Contrary1]

35. At the risk of sounding like a "scientifically illiterate idiot",

What would be your expert opinion as to why they are saying breast self exam does no good?

[Lance_Boyle]

50. because every fatty lump or varicosity leads to more expensive testing

BSE has a higher false positive rate than mammography.

[applegrove]

20. I don't think they can read mammograms of women in their early forties. Too much dense tissue to

see any lumps. None of this applies to women with a family history of breast cancer or any other risk factors.

[Odin2005]

23. Our society-wide case of hypochondria drives up healthcare costs.

[marlakay]

28. Don't ya know women cost the health insurance companies

more....ugh!!!!!!!!!!!!!!!!!!

[havocmom]

36. Yep. Dead is SO much cheaper for insurers than surgery, chemo, radiation, reconstruction

They have no problem with dead earlier than need be.

[Contrary1]

29. I would most likely be dead now without self-exam...

I found my own tumor 6 months after having been given the "all clear" report via mammogram. Trouble was, it wasn't all clear. It was obvious on the film. So obvious, that it had been circled with a question mark. Some nitwit failed to write it up in the report.

As a breast cancer survivor, this recommendation infuriates me. I belong to a rather large online group of fellow survivors. I would put the number of women there diagnosed before 50 years of age at about 80%, if not more.

Unless statistics have changed in recent years, most women find their own cancer during self exam.

What the hell are they thinking? I certainly hope it is not the first thought I had upon reading this. And would they want their own mothers, wives, sisters, and friends to follow this new advice? I would bet not.

[change_notfinetuning]

31. Look, it was either wait until 50, or do just one breast. They flipped a coin and

age 50 won.

Makes about as much sense as everything else we're hearing regarding health care reform.

[DU GrovelBot]

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[Raineyb]

37. They can kiss my ass

My mother was diagnosed at 33. I started having mammograms at 30 and I'll be damned if I wait until my 50's to do them. My mother was dead at 42.

[noiretextatique]

39. so sorry, Raineyb

:hug: it's been two years since i was diagnosed (lumpectomy and radaiation) and so far so good.
i am taking up the fight for breast mris for cancer survivors. insurance companies don't want to pay for them but research is proving them to be more effective than mammography. plus, women who have been through radiation treatments should not be exposed to more radiation from mammography. my doctors's plan was to alternate breast mris and mamograms every six months, but the insurance company death panel decided not to pay for the breast mris...mammograms are cheaper.

[Raineyb]

46. Thanks.

I've heard of the MRIs. I think it's what my sister needs because she foolishly got breast implants. (And I was really angry with her for doing it considering the family history and all)

I would much prefer the MRI as the idea of squeezing my breasts into that torture machine does not appeal but to be honest I'm lucky to get the mammogram at this point. My aunt had to fight to get hers before 50 even with the family history over a decade ago. The insurance industry is really not interested in trying to making people well or keeping them that way and that our representatives insist they these murderous, rapacious bastards should even have a seat at the table really pisses me off. That they would work to even deny the bit of care people can get now is inexcusable.

[PVnRT]

38. Had the lazy reporter who wrote this article bothered to read the source information

he would realize that the "government" is not saying "skip mammograms."

"The USPSTF recommends against routine screening mammography in women aged 40 to 49 years. 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."

http://www.ahrq.gov/clinic/uspstf09/breastcancer/brcanrs.htm

Given that the ACS and other doctor's groups still say that you should get mammograms at age 40, I doubt this agency's recommendation (note: not law) is going to carry any weight.

[dflprincess]

41. Unless the insurance companies listen to it and use it as an excuse

not to pay for mammograms for women under 50 and only every other year for those 50+.

That's the only place it might carry some weight.

[KatieW]

42. My sister passed away a couple weeks ago from Breast Cancer, and I was shocked when I heard this.

What are they thinking!!!! I especially was blown away when they said they didn't recommend woman do regular self exams. WTF!!!! What were they smoking when they came up with that decision? My mom is a breast cancer surviver, and she found her lump from a self exam. THEY DO WORK!! What's next, them telling me, what with my strong history of family breast cancer, that I don't have to have regular mamograms?

[pitohui]

45. i would suggest reading before you post because they didn't say any such thing

women w. a strong history of breast cancer have to follow a different protocol from women w. no history of breast cancer -- this is made pretty durn crystal clear

mammograms/biopsies to test what turns out to be a benign cyst has a significant risk, as i said in the other thread, a client of my mother's lost not only the breast, but an arm, and her legs because she was infected during the biopsy -- it turned out the cyst was BENIGN

her life was destroyed because of an unnecessary test

women who are at low risk/have no family history need to fully informed -- there is no level of radiation that is without risk and right now we do not know how many breast cancers are actually caused because young women have been exposed to radiation from mammograms, etc. for decades

plus younger, denser breasts give off plenty of false positives, lots of chances to require unnecessary re-tests and further doses of radiation, lots of chances to have biopsies that carry the risk

all radiation and all surgery has risks, and women need to balance risk intelligently

it is not intelligent for ALL women to be exposing themselves to unnecessary doses of radiation at an early age

as for BSE, study after study has found they don't save lives, they just make jobs for whoever publishes this "information" -- even a stopped clock is right twice a day, and no one doubts that there is anecdotal evidence that some woman somewhere once found a malignant tumor through BSE but what most women find are benign cysts -- panic and anxiety do have a cost

if your family had a history of any other kind of cancer, you would accept that you would follow different protocols than women from families that didn't have that history -- only when it's booga booga breast cancer scare stories let's make sure women can't enjoy their bodies BREAST CANCER is it insisted that all women have to get lots and lots of unnecessary screenings

this proposal was way overdue if you ask me

my ob/gyn said some time ago, after some questioning, that some authorities did believe that mammograms should wait until after 50 -- just how many decades do you expect to be able to expose yourself to even low doses of radiation into fatty tissue w/out developing cancer? it's contrary to what we know abt health physics

[liberal_at_heart]

43. It is kind of strange isn't it?

I can see the logic. Generally speaking cancer is an older person disease. I have a genetic mutation that puts me at risk for getting it much younger but generally speaking the majority of all cancers happen as we age, as we get into our 50s, 60s, 70s, and beyond. The older you get the more at risk you are for many different kinds of cancers. So, it makes sense that maybe they're just not seeing very many cancers in 40 year olds. But, it does seem strange that this study seemed to focus only on mammograms. I do think that we could probably save some money by not doing as many tests. My gynecological oncologist wants me to have a pelvic ultrasound every 6 months. I can't afford that. I plan on getting one once a year but I certainly don't plan on getting it every six months. Believe me I know we want to do everything possible to save lives. My mother and grandmother both died very young from breast cancer and I have a gene mutation that puts me at greater risk for both breast cancer and ovarian cancer, but at the same time if we want healthcare for all in this country we do have to be willing to look at ways to be more cost efficient. In most countries that have single payer systems women only get preventative tests every two years. Which way is better? Which way saves more lives? Which is more affordable? Which way gets more people healthcare? I don't know. But if we want healthcare for all we have to be willing to look at these things.