The aim of medicine is above all else, to do no harm. But one must wonder if that will be the case with a new medical recommendation on the detection of breast cancer.
For years, experts widely agreed that mammograms beginning at age 40 provided the best way for early detection of breast cancer. But new guidelines released this week by an important federal task force recommend a drastic change and raise new questions about the benefits of testing and exams.
The panel says women don’t need mammograms until they’re 50 and then only every other year, not annually. The potential harm of annual testing outweighs the benefits, the panel found. It was the first breast-cancer reassessment since 2002 by the U.S. Preventive Services Task Force, which typically guides federal policy.
The guidelines could have a far-reaching impact in the national debate over health-care reform. About 39 million women undergo mammograms each year in the United States. Critics worry that the policy shift could be a major setback for health, if insurers eventually scale back mammogram coverage for women in their 40s.
Published in the journal Annals of Internal Medicine, the guidelines have puzzled cancer doctors and contradict what many women have been told previously.
“We’re not saying women shouldn’t get screened. Screening does save lives,” said Diana Petitti, vice chairwoman of the task force. “But we are recommending against routine screening.”
The panel said women should wait until their 50s to begin having a mammogram every two years, and continue that schedule until age 74. It also recommends against teaching women how to perform breast self-exams, saying they don’t save lives.
The guidelines were immediately condemned by expert groups, including the American Cancer Society, and have sparked fierce debate about routine screenings.
The guidelines were hailed by some physicians, however, who say the new recommendations may help protect women from false-positive results that incorrectly signal cancer and could lead to unnecessary anxiety, biopsies, and invasive surgeries.
The deep divide in the medical community underscores the need for improved technology and more research about breast cancer — how to prevent, detect, and treat the disease.
Unfortunately, with the new guidelines there are no clear-cut answers for women to figure out when to undergo screening and how often. Many women are understandably confused by the mixed messages. But they should remember that the guidelines are just that — merely advice.
In fact, Kathleen Sebelius, the secretary of health and human services, says the independent task force’s recommendation won’t change federal policy.
Women should consider the new guidelines and their personal medical history while talking with their own doctors about how to best protect their health against a potentially deadly disease.
More than 192,000 new cases of breast cancer are expected this year in the United States, and 40,000 deaths.
No one disputes that early detection remains the best tool to save lives.
It will be poor women who end up increasing the rate of death from breast cancer a decade from now, and they'll be outraged if they understand how. I'll explain. For many decades, Preventive Medicine in the United States was focused upon diminishing mortality and morbidity in general. That's why we spend so much money upon vaccinations, pap smears, colposcopy, colonoscopies, mammograms, biopsies, etc. to prevent disease from killing us. In the meantime, British and Canadian health commissions hold a different preventive medicine paradigm. Their paradigm mixes in concerns about risk vs. benefit in addition to concerns about cost-benefit (a Soviet and Chinese model). There will always be cost and risk. Although Obama claimed over and over that Preventive Medicine reduces costs, everyone of authority in Preventive Medicine knows that it increases costs, and now we see it through the example of mammograms. Also, every procedure/medication has its inherent risks. But if the risk of any surgery is bleeding, infection, or death, will that stop you from getting a life-preserving procedure (i.e. cardiac catheterization for an acute myocardial infarction) if the chances of the risks are far less than the benefit? Unfortunately, Medicare, the AHRQ, and many American academics in public health (who, as I mentioned in previous posts often practice little or no clinical medicine) have slid through a major paradigm shift in the past couple decades towards the British and Canadian perspectives. Of course, this benefits private insurance companies, as well, but they are not a factor in the paradigm shift. You can choose your own breast exams and mammograms for now... but eventually many doctors may ignore your breast exam concerns and deny you a mammogram when the Centers for Medicare and Medicaid Services drops funding for mammograms all over again. And now you know why it will be poor women who end up increasing the rate of death from breast cancer a decade from now.— constantine- For those who don't know, the UPSTF and the AHRQ are not Obamaites, Republicans, pharmaceutical toadies, or cronies of the private insurance industry. The AHRQ are a bunch of public health bureaucrats who are a part of Sebelius' Health and Human Services, and the USPSTF is a bunch of public health academics and statisticians who work for the AHRQ. They are not influenced by the aforementioned Democrats, Republicans, Pharmaceuticals, or Insurance companies (note that pharmaceuticals only participate in public health studies when it involves vaccine or medication). Some Insurance companies, like the evil Kaiser Permanente (which focuses mostly on cost), conduct their own public health research, but very few devote any time or money in public health. But try to educate yourself and look at the AHRQ/USPSTF website: http://www.ahrq.gov/clinic/uspstfab.htm— constantine
- From their .gov website: "The USPSTF... recommendations are considered the "gold standard" for clinical preventive services... The mission of the USPSTF is to evaluate the benefits of individual services... make recommendations about which preventive services should be incorporated routinely into primary medical care... and identify a research agenda for clinical preventive care. It is AHRQ's mission to improve the safety, quality, efficiency, and effectiveness of health care for all Americans. The USPSTF is a prime example of the Agency's efforts to translate research on preventive medicine into practice. In keeping with its mission and the importance of prevention, AHRQ has augmented its support staff for the USPSTF and for its prevention programs in general. The AHRQ Center for Primary Care, Prevention, and Clinical Partnerships oversees operation of the USPSTF, and provides administrative, programmatic, and technical support for the USPSTF program....USPSTF recommendations have formed the basis of the clinical standards for many professional societies, health organizations, and medical quality review groups. Previous editions of the Guide to Clinical Preventive Services have been used widely in undergraduate and post-graduate medical and nursing education as a key reference for teaching preventive care. The work of the USPSTF has helped establish the importance of including prevention in primary health care, ensuring insurance coverage for effective preventive services, and holding providers and health care systems accountable for delivering effective care." Yes, you read it; the USPSTF sets guidelines and policies. If what they post is true (and it is), then you know that Sebelius is a liar. By the way, what were her "simple" recommendations about breast exams? Oh, she left that out, didn't she? And what great leadership did she provide over H1N1? She's an empty political suit who is ruining the HHS and American healthcare with her ineptitude.— constantine
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