The Mammogram "Study" and Impacts in #HCR

post from DemConWatch on 20 November 2009 05:00:00 AM. © DemConWatch

Earlier this week, the US Preventive Health Services Task Force published a report which concluded that the benefits to women under age 50 from mammograms were limited, and therefore regular mammograms for women age 40 - 50 should be discontinued for women without certain risk factors.

This was NOT a financial study, it was an efficacy report. It also was not an actual study, it was a lit review.

We have a strict policy here at DCW about not using curse words on the front page, or else I'd say that the US Preventative Health Services Task Force is full of _ _ _ _.

Over all, the report says, the modest benefit of mammograms — reducing the breast cancer death rate by 15 percent — must be weighed against the harms. And those harms loom larger for women in their 40s, who are 60 percent more likely to experience them than women 50 and older but are less likely to have breast cancer, skewing the risk-benefit equation. The task force concluded that one cancer death is prevented for every 1,904 women age 40 to 49 who are screened for 10 years, compared with one death for every 1,339 women age 50 to 59, and one death for every 377 women age 60 to 69. - NY Times

They fear overscreening. The report also indicates that there is "anxiety" while women wait for biopsies that end up showing that they do not have breast cancer. "Anxiety" is the "harm" they cite.

Kathleen Sebelius has said that both Medicare and Medicaid will continue to pay for screening mammograms for women in their 40's. So far, no private insurer has said they will discontinue coverage. Most doctors, the American Cancer Society, and virtually all normal, rational people who know anything have disagreed with the Task Force's conclusions.

And you should, too. Read the first sentence of the quote again: it says that reducing the breast cancer death rate by 15% is a modest benefit. Do you love a woman? Yourself, your mother, sister, daughter, wife, girlfriend, lover, friend? If she is one of the 15% saved by a mammogram in her 40's, is that a "modest benefit"?

I've written before about cancer treatments and how the cure rate has not improved in 60 years, EXCEPT relating to cancers which are found early, and treated early. Breast cancer is one of those which has shown great increases in cure rates for the Stage 1 and 2 diagnoses.

The timing of publication could not have been worse, from a strictly political standpoint.

For Republican Rep. Dave Camp of Michigan, the mammogram study was the best weapon Republicans could have. "This is the preview of what the movie's going to look like if the Pelosi health care plan or the Obama health care plan passes," Camp says. [...]
To Camp, the task force's recommendations for fewer annual mammograms was a much more effective way to make the argument about rationing than the hyperbolic complaints about death panels heard at town hall meetings last summer, which Camp said were not very helpful..
"Some people discounted the idea that the government would actually put people to death," Camp says. "And this actually is really showing how the insidious encroachment of government between the patient and their doctor plays out. And it's not a pretty sight."

Luckily, this is NOT a political discussion. It's a medical one, and smart people are ruling the day. First, ONE study should VERY RARELY be THE conclusion. Think coffee - it's good for you, it raises blood pressure, it prevents Alzheimers, it dehydrates you, it improves metabolism. You can find it ALL. The rare time that ONE study should be THE conclusion is when tens of thousands of people are followed for several decades. (I'm thinking of the Nurses Study) -- but normally studies are too short and involve to few people to be the final word.

Further, when you think "republicans" and "breast health", I want you to remember Senator and (amazingly) Doctor Tom Coburn. He's a fan of breast implants, he thinks they make women healthier. You only think that's snark, and I'm making it up, but no. He really said it back in 2005.

In conclusion, when you hear the IIE say that this study is PROOF of the downside of health care reform, remind them that cooler heads are prevailing, and a 15% reduction in deaths is a good thing. Then, remind them that WE are smart enough to ignore things that make no sense in vivo.