November 17, 2009

Under the new mammogram guidelines, "billions of dollars will be saved."

"But the money was buying something of net negative value... This decision is a no-brainer. The economy benefits, but women are the major beneficiaries."

What is this benefit to women here? It is not going through the anxiety of a test that may produce a false positive and require additional tests!

165 comments:

vbspurs said...

As I mentioned in the other thread, women in Britain rarely get yearly mammogrammes. That would be a drain on our NHS resources.

And oh, what a coinkidink that this federal commission came to a stunningly stupid not to mention dangerous conclusion just when the US is poised to have some kind of socialised health care.

Oh and kiss those epidurals goodbye, ladies. Doesn't happen when the State pays.

Cheers,
Victoria

former law student said...

In fairness to commenter "Ignorance is Bliss," I will call the medicos' new policy, "What you don't know won't hurt you."

The idea of risk factors based on family history is a bit puzzling to me, because every family member whose history I know died from something different. My wife was diagnosed with a disease that no one in her family had ever had -- not a "lifestyle disease." Luckily we caught it in time.

Terri said...

Mustn't upset the ladies....

http://ithinkthereforeierr.wordpress.com/2009/11/17/mammograms/

Edgehopper said...

This is part of the problem with government health care reform--it ensures that politics will always get in the way of science. From looking at the statistics, this is probably the right medical call for the vast majority of women. But thanks to the push for Obamacare, it's impossible to get the science out there without everyone thinking that there's an ulterior motive to save money at the cost of people's lives.

Tom Spaulding said...

So...DON'T save the Ta-Tas? What to do with this pink ribbon?



wv:bulema - binge colonics

davis,br said...

So the Death Panel backroom bureacratic maneuvering is already beginning, eh?

...and they don't want teh wimmen folk to even be taught proactive self-exam breast screening? WTF!

I guess the ladies are the first to be thrown under the Obama Boobie "Health"care Omnibus.

Hey, how's that vote for Obama working for you now Professor?

Paddy O. said...

"What is this benefit to women here?"

A case of the vapors can be very traumatizing and socially awkward. Of course, the smelling salts industry might balk.

Ben (The Tiger in Exile) said...

Middle-aged women -- under the bus!

(Off to the ice-floe?)

Pogo said...

Of course, "billions of dollars will be saved" is the whole point of national health care in the US.

Saved for whom, you ask?
Not youm.
Them.
The gummint.
Because they'll spend it on something. Don't be thinking it will redound to your pockets.

Some other health care will be covered with that money.
For someone, let's say more important than you all.

You goddamned proles are about to get what's coming to you.

John said...

"While many women do not think a screening test can be harmful, medical experts say the risks are real. A test can trigger unnecessary further tests, like biopsies, that can create extreme anxiety. And mammograms can find cancers that grow so slowly that they never would be noticed in a woman’s lifetime, resulting in unnecessary treatment."

That makes no sense. First, I think most people would gladly take the risk of a few unnessary tests in order to avoid the risk of having untreated breast cancer. Second, whatever axiety you get from a false positive, pretty much ends when you find out it was false. Again, most people would rather have that axiety than risk the real thing. Third, if the problem is that people are getting unneeded treatment of slow growing cancers, than the sollution is to stop treating slow growing cancers in older women. It is not to stop looking for all cancers.

Are the editors and writers of the NYT that stupid? How can they write such crap?

traditionalguy said...

Get used to it until Palin and the GOP comes into town. Today's Public Health poobahs see no limits on SEIU Grant and Steal programs disguised as Health Care Reform because that benefits the right people. All of you old white women shall now sit in the back of the bus and will soon be thrown under a Death Bus the day the Panel sees no other choices left to save the money to spend on really worthy causes.

The Crack Emcee said...

Women worry about their fucking health too much. Almost everything they do is designed to alleviate their fear of something being wrong - they are so fucking special you know - so they throw good money at nothing and then wonder why the economy is so bad. And they bug the shit out of men to become pussies like they are. Pioneer women would've laughed at them.

Get a grip - and a clue - and realize that if there's nothing wrong then there's nothing wrong, and get on with your life:

You're just yanking your own collective chain.

The Macho Response

The Crack Emcee said...

Oh, and I forgot the fucking kicker;

You're gonna fucking die, folks!

Get used to it.

John said...

Crack Emancee,

My grandparents were real no shit pioneers. They were only a generation removed from the homesteaders. They started a farm from nothing in the 1920s in Western Kansas. Either one could have kicked your sorry ass. But they still went to the doctor and didn't have any desire to die a panful death in the name of manliness.

Cedarford said...

It's going to be a rough transition. For 60 years we have operated on the premise that America can afford anything at any cost "even if it just saves one precious life". But that was based on us lucking into being the only major nation not wrecked in WWII and dominating technology, productivity and wealth pouring in because the dollar was king.

Now we can't compete too well. We have a legal system that greatly retards our nimbleness to new challenges and fixing our serious deficiencies (cannot manufacture goods better and cheaper than our rivals, healthcare 60%-120% higher than our rivals, our schoolkids now near-bottom of all developed nations.).

So we are headed for a time when our declining wealth and abilities vis a vis our rivals must mean we budget the greatest good for the greatest number.

Kevin said...

Any bets that Michelle Obama will continue to get mammograms?

former law student said...

Women worry about their fucking health too much. Almost everything they do is designed to alleviate their fear of something being wrong

Women's reproductive systems often kill them -- they need, for example, to get a Pap smear every year. The routine of the annual ob-gyn visit gets them in the habit of seeing a doctor.

I know two breast cancer survivors in my circle of acquaintance, so this is not some weird disease that happens to other people.

Pioneer women would've laughed at them.

Not if they died in childbirth.

lucid said...

Welcome to government, non-private health care. Just don't say the recomendation came from a "death panel."

lucid said...

And the billions that we save can be given to ACORN!!!! Yay!!!!

The Drill SGT said...
This comment has been removed by the author.
Darren Duvall said...

than the sollution is to stop treating slow growing cancers in older women. It is not to stop looking for all cancers.

This is a real concern, the analogue in men is prostate cancer -- there's the 'old man' prostate cancer that pretty much every man will get if they don't die of something else (80% of men 80 years old are expected to have prostate cancer cells if you biopsy them), and the Bill Bixby-Frank Zappa-ultra-aggressive prostate cancer that happens earlier.

We can find DCIS with mammography, and we can identify high-grade, aggressive DCIS most of the time. Dr. Lazlo Tabar, the guru of the Swedish mammography program, believes high-grade DCIS to be the most aggressive of all breast tumors. But there is no imaging way to determine the number and type of mutations in a given population of cancer cells, and even at biopsy when you have tissue in-hand our ability to "run the DNA" and identify mutations associated with aggressive behavior is limited.

Basically, it's easier said than done to not treat slow-growing cancers, because we lack the ability to determine when a cancer will develop mutations that make it more deserving of aggressive treatment. It could be ten years from now, it could be next week when the patient takes that plane flight to go see her grandkids. There is no way to know.

Elliott A said...

No one has ever died from a mammogram. No one has ever had one without first consenting to it. No one has ever had a follow up test without consenting to it. No one has had surgery without consenting to it. So why do these people need to be protected from the anxiety? They know the stats, the risks and choose the next step or not.

Too Many have died from not having a mammogram. And for me it is still too many if it is ONE! What kind of people are we if we look at cost benefit ratios where there will be unnecessary deaths.

traditionalguy said...

Crack @ 11:29...It's a timing issue. God blesses us with a full life span, and the MDs are His servants in this and earn their pay. Dying young is the curse. Death is unavoidable, but to not live your full lifespan is avoidable. That is why you hammer the cults all the time. The cults kill, steal and destroy.

The Drill SGT said...

What is this benefit to women here?

no co-pays?

no out of pocket mammograms for these millions of women w/o health insurance?

lower rates?

increased divends on the Health care stock they own?

lower taxes?

If it saves billions, almost by definition, women will have a return of half that amount in some fashion.

Pogo said...

"must mean we budget the greatest good for the greatest number."

AKA
"From each according to his ability, to each according to his need".


And "we budget the greatest good" prompts me to ask,
Whatchoo mean we paleface?

SteveR said...

Here's the problem I see, you've have a long period where regular mammograms (past a certain age) and self examination were preached and widely known in the culture.

If, as many have suggested, the efficacy of this has become less certain, its reasonable to adjust the standards of care.

But you are changing (actually getting rid of)a long held system based on a gradual re-examination of data, but doing so quickly at a time when the health care system, in total, is in prime focus.

Verdict: bad timing and bad technique.

WV: knofun nope, it isn't.

John said...

Darren,

The side effects for treating cancer are so ghastly, I can't imagine agreeing to such treatment if I were in my 70s and had a slow growing cancer. Granted, it is a bet I might lose. But, chemotherapy and radiation are pretty much gaurenteed to ruin my quality of life and might not help anyway.

Darren Duvall said...

Oh, and without tort reform, good luck finding the folks to read your every-two-years mammograms. Mammography is already the most heavily-regulated part of medical imaging, the paperwork is a hassle and the liability is astronomical.

Now you expect me to read mammograms with half the data points to identify changes over time, and maintain the same level of liability?

Good luck with that.

MadisonMan said...

How much focus/screening is done for the #1 cancer killer in women? Maybe more should be done for that.

wv: cywaa (Cover your whiney achin' a$$)

ObamaNation said...

Lucid said: "And the billions that we save can be given to ACORN!!!! Yay!!!!"

Yes, that's right. And it will be money better spent. ACORN does great work empowering the disenfranchised, and if their work helps President Obama win re-election in 2012, then that's worth a few sacrifices.

How many millions have died in Bushitler McChimplyburton's war for oil?

And let's face it: Why do women even have breasts? It's for the benefit of male pigs, to ogle and fondle. Down with the patriarchy!!! Preventative mastectomies for all!!! (If that's what President Obama's panel of experts recommends. After all, they know better than you or me. But especially you, you inbred hillbillies).

Darren Duvall said...

John,

That's certainly a choice that any individual can make. My wife's grandmother had a breast cancer identified at biopsy, she elected for unilateral mastectomy without chemo or radiation almost 15 years ago and is still alive and kicking in her mid-80s.

The problem arises when the decision is not left to the individual and the government says, "That's a slow-growing tumor. We're not going to treat it." With current technology the government lacks the ability to determine when a slow-growing tumor will become a fast-growing tumor. Cancer cells are a) dividing faster than normal and b) already show evidence of inability to repair mistakes in their DNA. If any cells are likely to become more malignant, it is ones that are already well down the path.

Should we develop DNA technology that allows us, over time, to follow tumors and say "mutations at X, Y and Z indicate an A% probability of developing an invasive malignancy in B time period", then it's legitimate to sit after a minimally-invasive biopsy of that tumor is done and we know what we're dealing with.

That technology does not exist, at least to that granular level in wide practice, so until that level of probability can be achieved it is wrong to deny treatment. At least, that's my opinion.

TMink said...

"From looking at the statistics, this is probably the right medical call for the vast majority of women."

Advocating that women over the age of 74 not get tested is not about medical health, it is about letting people die so you save money. I think that there are serious ethical issues involved in at least this aspect of the recommenations.

Trey

Darren Duvall said...

How much focus/screening is done for the #1 cancer killer in women? Maybe more should be done for that.

The best program for beating lung cancer is to not get it. A 10mm small cell cancer has a 2-year survival rate of 10%. That's awful, and hard to find.

There have been attempts to do imaging screening for lung cancer. They have all failed, for various reasons. Plain film screening (chest x-rays) doesn't work. CT scans looked like they would work in NYC in the late 1990s, but couldn't be duplicated elsewhere and the whole midwest is loaded with histoplasmosis, a fungal disease that puts little round balls of tissue in the chest that could be but usually are not lung cancer.

We are currently awaiting more technical developments, protein markers for malignancy (the 'spit on a slide' test) may end up being the best screening tool, but from an imaging standpoint my recommendation is to not smoke. Period.

AJ Lynch said...

Under Obamacare, insurance premium rates can not differentiate for gender. So it us Guys who will save money on this too! Hooray!

MadisonMan said...

A 10mm small cell cancer has a 2-year survival rate of 10%.

What's the equivalent survival rate for such a sized mass in a breast? Do you know? (I don't, hence the question). The one link I found, from a study in Japan, showed better numbers than 10%

rhhardin said...

Imagine instead a test that results in 100% false positives (on the flip side, it never misses a case).

Should this test be given?

You could have cancer and it would detect it and save your life.

Most people can intuit that this test is worthless; yet at some false alarm rate below 100% there must be a place where it becomes worthwhile.

What is that point, and do mammograms fall below it, is the question.

The Crack Emcee said...

"My grandparents were real no shit pioneers. They were only a generation removed from the homesteaders. They started a farm from nothing in the 1920s in Western Kansas. Either one could have kicked your sorry ass."

You talk like I've never encountered "real" women before:

My foster mother (black, poor, ignorant, former slave-style sharecropper, lived on "bad" food, etc.) rarely went to the doctor, never took a vacation, and raised, at least, 15 kids almost singlehandedly while turning our house in L.A. into a functioning farm. She lived to be over 100 years old.

You guys (including the guys) are a bunch of worry-wart pussies. You've bought into the NewAge idea of "wellness" (health beyond good health, or the attempt to attain "good health" when there's nothing wrong to begin with) just as I hear the other NewAge-inspired totems of "Big Pharma" and "Big Oil" repeated endlessly. You have no minds of your own and can't tell reality from make-believe.

NewAge thinking is the main cancer we need to protect ourselves from.

Henry said...

I'm in agreement with Edgehopper. This is probably the right medical call, but the political interpretations are malignant.

One of the underlying questions is whether or not the government even make this judgment. In a perfect pay-for-service world, perhaps not. Each doctor could individually consult with each patient and determine, based on the patient's medical history, and the doctor's knowledge of the medical literature, whether the mammogram is appropriate. We are assuming that the doctor knows the literature and the patient is rational.

But the government is in the healthcare business. Even now it covers senior citizens, veterans, and the poor. It mandates requirements for private insurers. Thus it has a responsibility to make decisions about how medical resources are spent.

In this environment, and in the environment of community rating for private insurers, we are very far afield from the pay-for-service model. This means that patients and doctors (and radiologists!) don't really have to justify the cost of their decisions. It is very easy to criticize denial of service when someone else is paying the bill.

Go back to the pay-for-service model. Assume your doctor tells you that you can take a screening test. It will cost you $500. There's a 10% chance that you will get a false positive and have to take another test. Another $500. There's a 1 in 1,000 chance that a malignant cancer will be detected and treating it now will be 50% more effective than treating it a year from now. There's another 1 in 1,000 chance that a non-malignant cancer will be detected, and you will pay tens of thousands of dollars for unnecessary treatment. You may get sicker in the process.

What's your choice?

The Crack Emcee said...

Oh - and she did all that while standing up to gang-bangers.

You suckas, today, never would've lasted.

prairie wind said...

Maybe the mistake was made back when government required all insurance policies to cover mamograms. Now people see those annual mamograms as an entitlement. Did the medical industry push annual mamograms because they knew the insurance companies had to cover them? Is it possible that we were led to believe in the need for mamograms and now it's hard to let go of that belief?

I don't know the answer. I do agree with those who point out the poor timing of this announcement.

Shanna said...

So, according to the article, getting mammograms prevents 1 in 1900ish deaths if done 40-49, and 1 in 1330ish deaths if done 50-74.

And the great benefit of not doing this (not saving that 1 in1900) is:

"A test can trigger unnecessary further tests, like biopsies, that can create extreme anxiety. And mammograms can find cancers that grow so slowly that they never would be noticed in a woman’s lifetime, resulting in unnecessary treatment. "

This is pretty pathetic reasoning to me. And look what countries they studied, Sweden and England! But it's not political or related to Universal health care at all.

chickenlittle said...

Oh and kiss those epidurals goodbye, ladies. Doesn't happen when the State pays.

Yep!

Beginning and end of life care will change too. Basically, the move will be to wean Americans off hospitalization for things such as birth and death.

Oh and early detection? You'll still get your chemo, but forget about early detection.

Chris said...

No "breasts" tag?

Alex said...

I agree with Crack Emcee, it's time for women to man up here and get tougher! They are such sissies about their health care...

ricpic said...

I hope women in their tens or even hundreds of thousands get busy calling their senators so this thing dies in the senate.

Darren Duvall said...

What's the equivalent survival rate for such a sized mass in a breast? Do you know?

Source

Any breast tumor less than 2cm in diameter without spread to lymph nodes has a 100% five-year survival rate with treatment. A tumor less than 2cm in considered Stage I. Even if there is spread to 1-3 lymph nodes, the 5-year survival rate is still 92%

The number I quoted is specifically for small-cell carcinoma of the lung, the most aggressive form of lung cancer. Non small-cell tumors have a better survival rate, but not by a whole lot. SCLCs are bad because, like pancreatic cancer, they are more likely to have spread by the time they are detected.

Dark Eden said...

Billions will be saved in mammogram tests that don't happen and billions more will be spent on things that would have been caught by those tests but won't be now. And who knows how many people will die because these things weren't caught in time.

wv: prone. What the Democrats want you to be at all times.

Shanna said...

Pioneer women would've laughed at them.

Not if they died in childbirth.


For real. There is a reason women worry about their health. God, even the article in favor of stopping the mammograms says they save on in 1900 lives. These are real people who would really die if they didn’t get a mammogram. I know one breast cancer survivor in my office of 7 people, only 5 of them women. You don’t know what you’re talking about.

Darren Duvall said...

Henry,

A fee-for-service model would be considerably cheaper than the current model, because we could set prices based on what things actually cost, rather than setting an inflated 'price' and still be able to cover expenses once insurance company discounts are taken into account. Rather than being $500, a mammogram would probably be $100 or less, and a workup mammogram including an ultrasound $150. A image-guided biopsy would be $200. Going to cash would remove the inflationary effects of some patients having insurance and some not.

There are not 'non-malignant cancers', there are things that need treatment and things that don't. The only grey area is something called 'atypical duct hyperplasia', and that is probably 1% of all image-guided biopsies that go on to require surgical excision, but do not prove to be malignancies. Low-grade malignancies are still low-grade, the question becomes whether the patient will live long enough for the tumor to become aggressive and life-threatening.

The Crack Emcee said...

Women don't have to "man up here and get tougher" but just get over themselves - it's NewAge that's convinced them they're so fucking special to begin with: They outlive men as it is - gaining whatever the poor dead bastard, who worked his ass off out of love for them, attained/built/created - but I don't hear them crying over that discrepancy.

Ungrateful bitches is what they are. What's the phrase? Oh yea:

Because you deserve it!

Needless to say, pussy is over-rated.

REK said...

Lest we allow details to muddy the waters, the new guidelines apply to a subset of women only. For women outside the designated subset, existing guidelines appear to persist.

XWL said...

When mammograms are outlawed, only outlaws will perform mammograms.

OK, nobody's saying to outlaw the procedure, just seems they're setting the groundwork for Obamacare to not have to pick up the tab on women under 50 and over 74.

Let me rephrase, when mammograms aren't subsidized, only enthusiasts who would perform mammograms for free will perform mammograms.

I seem to remember Howard Stern offering 'breast exams' during breast cancer awareness month.

JAL said...

"can create extreme anxiety"

Oh good grief.

Little wimmen with anxiety.

Get the smelling salts.

Sexist.

Original Mike said...

"A test can trigger unnecessary further tests, like biopsies, that can create extreme anxiety"

I am SO effing tired of this argument. Pretty much all of us experience anxiety over health issues. It's unpleasent but it doesn't kill you. Cancer kills you. End of analysis.

Shanna said...

They outlive men as it is - gaining whatever the poor dead bastard, who worked his ass off out of love for them, attained/built/created - but I don't hear them crying over that discrepancy.

Oh no! Women outlive men. I suppose that means if you have cancer you should roll over and die, just to make the guys feel better about that. WTF, Crack? You have some issues.

DADvocate said...

Costs too much? We'll take a chance with your health.

This will be the credo of government run health care, get used to it.

Triangle Man said...

Cancer kills you.

Except for the vast majority of the time when it doesn't

AJ Lynch said...

The bottom line is this is just govt & bureaucratic micro mgt.

Alternatively, freedom of choice would allow everyone to spend XX amount of dolars per year on whatever you want. I think that is what a HSA does.

Unfortunately, we will have no choice under Obamacare!

jayne_cobb said...

"...our schoolkids now near-bottom of all developed nations..."

When arguing for a government takeover of healthcare you may want to drop any mention of our state run education system.

Ricardo said...

"Ask not what your country can do for your breasts, ask what your breasts can do for your country."

Or something like that.

Pogo said...

No abortions and no mammograms.

Just imagine what would happen if Democrats weren't feminists!

rhhardin said...

Money saved means money spent some other way.

Since it's government that's spending it, there's no particular reason to think it will be better spent.

If were a question of your own money, it would go to whatever has the higher value to you.

That's why guys never go to the doctor.

prairie wind said...

"Cancer kills you.

Except for the vast majority of the time when it doesn't"

So maybe the anxiety we feel over cancer that leads us to get annual mamograms is not necessary? And if the anxiety isn't necessary, what about the mamograms?

Alex said...

Needless to say, pussy is over-rated.

Crack - are you a homo?

Alex said...

Isn't cervical cancer far more dangerous? Why all this gnashing of teeth about the breasts? The pussy is where the REAL action is!

former law student said...

When arguing for a government takeover of healthcare you may want to drop any mention of our state run education system.

Actually, Obamacare would be analogous to school vouchers, not public schools. If we had an educational system comparable to Obamacare, most everyone (e.g. not active military or veterans) would go to private schools, but people who could not afford the tuition -- and who previously had been uneducated -- would receive tuition subsidies.

Joe said...

Studies from Europe found that mammograms starting at 40 were resulting in false positives which were resulting in deaths. They also found that it was leading to an increase of breast cancer.

The phrasing of this announcement was poorly done, but the science behind it is very solid. Mammograms are killing women who would not otherwise have died. Mammograms also have a spectacular false negative rate. For women under 50 they are, in fact, a lousy diagnostic tool objectively speaking.

Someone brought up prostate cancer. There was recently a big push for prostate testing. Turns out, though, that general testing has almost no effect on overall mortality and there were some indications it was making things worse for many of the same reasons as the mammogram issue--doing any medical procedure where you are sedated has a risk of death.

If we are to go down the path that any diagnostic tests that may save a life will be mandated, even if they result in other people losing their lives (or being harmed due to unnecessary procedures?)

Henry said...

Darren -- thanks for the feedback. While I'd like to see a really accurate cost-benefit model, it hardly matters in the current system when the benefits are seen and the costs are unseen.

Even in the current system, if a free-market mammogram can be pushed down to $100, I would think that any move (by government or regulated insurers) to only cover mammograms at age 50 would create demand for free-market screenings for those under age 50.

Dark Eden said...

Actually, Obamacare would be analogous to school vouchers, not public schools.
>>>

There are plenty of youtube clips of Democrats in front of friendly audiences admitting that the end goal of Obamacare is the complete takeover of the private sector. You guys can hem and haw all you want but that is the obvious truth to anyone paying attention.

On the mammograms. My fiance gets one of these a year, and I would hate to have her health threatened because they need to save a buck in their government takeover.

former law student said...

the end goal of Obamacare is the complete takeover of the private sector.

Well the end goal of the Patriot Act was to put all liberals into reeducation camps in the Sonora Desert. So there, Mr. Boogeyman.

Shanna said...

Isn't cervical cancer far more dangerous? Why all this gnashing of teeth about the breasts?

Most women start getting a routine yearly pap smear in their teens or twenties. Why do you think they go to the gynecologist every year? It hasn't been mentioned because nobody has suggested we just stop doing those just yet.

k*thy said...

These *new* recommendations date back more than a decade, were adopted by most other first world countries, but were not adopted here for political reasons. In 1997, The National Institutes of Health (NIH) Consensus Development Conference on Breast Cancer Screening for Women Aged 40-49 … concluded that data on the benefits and risks of screening mammography for women aged 40 through 49 are sufficiently mixed that informed decision making, rather than a blanket recommendation for all women, is an appropriate course of action.

Even yesterday's recommendation says the decision should be an individual one and take into account patient context, including the patient's values regarding specific benefits and harms.

So, I'm not sure what the howling is about.

Even with these two consistent recommendations, as we learn more about diseases (as we are learning with breast cancer, that it’s not a constant), we need to apply what we learn. If it calls to be more discriminating in our treatments, we should.

Roger J. said...

It does seem to me we can argue from epi data, all of which is great for the population as a whole--the issue is that if you have the cancer, then you are an outlier from the data. But if you are the outlier, your future looks a whole lot different--assess your risks in consultation with a medical professional and make a judgment about what you should do--To me that is an intensely personal decision, and one the government should not be involved in. Every one's capacity for risk is different--when you force it into a once size fits all approach--that ANY bureaucracy will end up doing--you take the individual out of the picture.

And we should all remember: life itself always has a bad outcome. As an epidemiologist, I can state with 100 percent certainty that we will all die--I just can't tell which you are going to die when.

edutcher said...

The one thing nobody has mentioned is that, since Miss Sarah first raised the subject of 'death panels', this little revelation should be worth a least 100,000 more copies sold.

WV "whica" A witch with gas.

Triangle Man said...

Darren,

Are you saying that all cancers are ticking time bombs and need to be treated, or are you saying that you can not distinguish between those that need to be treated and those that do not?

It seems pretty clear that since in the time since mammography became widespread in the U.S. that a lot more cancer is being detected that never would have been detected before (and which would not have caused symptoms or death). Screening did not reduce mortality from breast cancer, and mortality rates only mortality rates only started to decline until women stopped using hormone replacement therapy.

Original Mike said...

Me: Cancer kills you.

Triangle Man: Except for the vast majority of the time when it doesn't


You mean like when it's treated early?

The real bottom line is I don't want YOU making this decision for me.

Triangle Man said...

It hasn't been mentioned because nobody has suggested we just stop doing those just yet.

Because cervical cancer screening is effective. If widespread HPV vaccination is adopted and is effective, Pap tests may become unnecessary and the USPSTF may recommend that it only be performed among unvaccinated women, or every two years.

former law student said...

mammograms starting at 40 were resulting in false positives which were resulting in deaths.

Getting run over on the way to the hospital? Infections from resistant staph bacteria? Or what?

Once you know something you can decide what to do about it, if anything. But ignorance is not bliss if you want to live to a ripe old age, raise your children to adulthood, see them graduate from college, hold your grandchildren in your arms, or any similar goal.

campy said...

The real bottom line is I don't want YOU making this decision for me.

Well, good news: Triangle Man won't be making that decision, Barack Obama will.

You got a problem with that? You're a racist.

Alex said...

Crack seems to believe in "survival of the fittest" by withholding medical care.

Triangle Man said...

The real bottom line is I don't want YOU making this decision for me.


The real bottom line is that no one is making the decision for you. It's a recommendation from the USPSTF based on the best currently available evidence (including several clinical trials). If it weren't such a serious topic, the hysteria surrounding the recommendation would be hysterical.

Shanna said...

It seems pretty clear that since in the time since mammography became widespread in the U.S. that a lot more cancer is being detected that never would have been detected before (and which would not have caused symptoms or death).

A lot is being detected that WOULD have caused symptoms and death too, don’t you think?

Screening did not reduce mortality from breast cancer

Really? Where are you getting that data? The Nytimes article said for women 40-49, one in 1900 individuals saved from death by screening and 1 in 1330 for 50-74. So, I’d love to see some data on that.

Because cervical cancer screening is effective.

I brought this up because someone asked why we were worried about breast cancer when cervical cancer is more deadly and the answer is that we are already screening for cervical cancer.

Obviously, if you never get cancer none of this matters. But there are a lot of people who do get cancer and it might be life or death for them. So, unless we have really good data telling us not to, I don't see why we can't err on the side of caution. I'm willing to be persuaded by good science, but "those poor women get so much anxiety if there is a false positive" is not a good argument.

Alex said...

BTW, the real issue here is racial disparity. Minority women are far more likely to die of cancer then wealthy white women. This is a fact.

Gretchen said...

Two of my three sisters had agressive (HER2+) breast cancers detected due to routine mammography. Both were under 50. That's evidence enough for me, thank God they are healthy now. Under the current system it's fine with me if health insurance refuses to pay, I'll get them anyway. Will a government run system allow that or allow for follow-up diagnostics should something be discovered?

Next Obama will accuse doctors of loping off breasts to make a few quick bucks....

amyw said...

The phrasing of this announcement was poorly done, but the science behind it is very solid. Mammograms are killing women who would not otherwise have died. Mammograms also have a spectacular false negative rate. For women under 50 they are, in fact, a lousy diagnostic tool objectively speaking.

I am skeptical of this claim... if it were true that early screening for breast cancer lead to more deaths, you would expect countries (like the UK) that do not encourage women over 40 to get regular mammograms to have survival rates that are equal to, or higher than, rates in countries that do encourage early screening. The statistics DO NOT support this. For breast cancer, the US has a 83.9% five year survival rate. The UK's five year survival rate is 69.8%.

Moreover, this differential in survival rates carries over into other cancers for which there are regular screening mechanisms.

The five year survival rate for prostate cancer in the US is 91.9%... in the UK it is 51.1%.

The five year survival rate for cervical cancer is 71% in the US and 62% in the UK.

For colorectal cancers, the US five year survival rate is 65%. The UK survival rate for same is ~40%.

Screening for cancer does not save money but it does save lives. The problems start when the person doing the cost/benefit analysis isn't the person who will die.

knox said...

"But the money was buying something of net negative value... This decision is a no-brainer.

No-breaster, more like.

And the billions that we save can be given to ACORN!!!! Yay!!!!

Will be, more like.

prairie wind said...

"On the mammograms. My fiance gets one of these a year, and I would hate to have her health threatened because they need to save a buck in their government takeover."

So, don't threaten her health. Pay for the mamograms yourself. Or were you thinking that you needed insurance (or Uncle Sam) to pay for it? If we all had to pay for the tests out of pocket, the cost would come down.

Gabriel Hanna said...

@Darren

Studies from Europe found that mammograms starting at 40 were resulting in false positives which were resulting in deaths. They also found that it was leading to an increase of breast cancer.

Perhaps the European method of mammogram differs from that practiced here, but I am pretty certain that a mammogram cannot kill you or give you cancer.

Which is a snarky way of saying "correlation is not causation".

A mammogram might be a waste of money; but they are not harmful in themselves, regardless of what negative health effects a study finds they correlate with.

Roger J. said...

amyw: thanks for posting the survival rates--survival rates, IMO, are one of the best measures of the effectiveness of our health care system. Those that like to spout infant mortality or life expectancy have zero understanding of epidemiology.

To your point: as much as I think survival rates are the best measure of our health care system, they unfortunately conflate prevention and intervention mechanisms, and it is difficult to disaggregate that data.

There is a school of thought among some health care economists that says most forms of prevention in fact increase health care costs rather than reduce them. This rather draconian view relies on the fact that many people may outlive their conditions. That is probably true in the overall economics of health care, but doesnt do much to the person who needs medical intervention right now.

Triangle Man said...

@Shanna

Oh,I did screw that up. Let's
see if I can dig myself out.

All of the following is from the USPSTF evidence synthesis document:

It was incidence rates that declined in response to changes in hormone therapy:

"Age-adjusted incidence rates for breast cancer also declined each year during 1999-2003.12 This trend may be attributed to discontinuation of menopausal hormone therapy,11, 13 and a plateau or decline in use of screening mammography."

For mortality benefit related to screening:

"For women age 40-49 years, data from the Age trial and updated results from the Gothenburg trial from Sweden (age 39-49 years) were combined in a meta-analysis with 6 trials included in the previous review. Results indicate a relative risk for breast cancer mortality of 0.85 (95% CrI, 0.75-0.96) for women randomly assigned to screening, and a number needed to invite for screening to prevent one breast cancer death of 1,904 (95 % CrI, 929-6,378) over multiple screening rounds that vary by trial."

"An evaluation of mortality trends from 1990 through 2000 from 7 studies attributed 28-65% of the decline to mammography screening, while the remainder of the decline was due to improved adjuvent treatments.17"



So, screening provides the benefit you mentioned:

1 life saved out of 1,900 women screened over about 10 years.

From table 7 of the document, for this theoretical group of 1,900 women there would be (per year):

2 False Negatives (cancers missed)
186 False Positives
160 Additional imaging studies
18 Biopsies
3 Screen detected invasive cancers
1 Screen detected DCIS every other year


Of course, different women may interpret these harms differently and weigh them differently in their decision.

Triangle Man said...

Which is a snarky way of saying "correlation is not causation".

How about a correlation in a clinical trial?

Shanna said...

Perhaps the European method of mammogram differs from that practiced here, but I am pretty certain that a mammogram cannot kill you or give you cancer.

I’ve been reading the NY Times comments on this, and someone said this study was done on an old type of mammogram.

It also seems that many people got breast cancer in their 40’s, usually with no family history, and many found them by self-exams, which is why I’m dumbfounded that they seem to be discouraging that.

rhhardin said...

Ticking time bombs is old technology.

Shanna said...

Thanks Triangle Man. I hadn't seen the false pos/false neg/biopsy, etc.. data. Very interesting.

Triangle Man said...

For breast cancer, the US has a 83.9% five year survival rate. The UK's five year survival rate is 69.8%.

Unfortunately, survival rates are a bad way of evaluating the effectiveness of screening. Two biases (lead time bias, and length bias) occur when the evaluation of screening is done based on survival rates. Survival rates can appear better when 1) disease is diagnosed earlier by screening, even if treatment is not effective or harmful simply because the patient is aware of the diagnosis for a longer period of time than they would have been otherwise (i.e. lead time bias), and 2) periodic screening is more likely to detect slow growing tumors that are less aggressive and take longer, or will never, cause symptoms and death (i.e. length bias). Again, survival can appear better with screening than without screening even if the treatment is ineffective, or is harmful.

MadisonMan said...

Darren, thanks for the comparison between lung/breast cancers. Very interesting!

MikeR said...

This is one crazy thread. This is a perfectly normal and proper discussion in medical science: Is a particular procedure efficacious? In my lifetime, many such issues have changed. When I was a kid, they prescribed milk for an ulcer. Then doctors decided that milk is bad for an ulcer. And so on.
It takes time to work things out. What is bothering you all?

Paul Zrimsek said...

Following the methodology established for the stimulus program, every $100 less spent on mammograms will have to be counted as a job loss.

Michael Hasenstab said...

You are taking the sucker bet and going down the side street of mortality and morbidity data, anechdotes and other distractions. All of it is planned to distract you from the sad truth you happily overlook:

Under government healthcare, you no longer own your breasts.

They are property of the US Government.

You and your MD cannot decide which health treatments, procedures, examinations, surgeries and repairs your breasts will receive. That will be determined by the government. If twenty percent of the breasts in your breasts' age group never get cancer, then youre won't either.

Or if they do, well, then, the government hasn't budgeted for that, so take a few months before the pain sets in to say goodbye to your children, your husbands, your lovers, your families.

It's not just your breasts that the government own, of course, it's your entire body. The government will own your body. Think not? Then try buying private insurance and see what happens.

The healthcare bills before Congress, in their various forms and names all allow the federal government to take ownership of your body.

Have you lost all sense of freedom? Or are your going to just continue quibbling over how many roentgens of x-rays each age cohort will be allowed to receive?

Wake the fuck up, people! The goveernment is about to enslave you, and your are happily dithering with obscure details that help you rationalize that this s a good thing.

Eva said...

Crack Emcee - Why would women "get over themselves"? We're making you die early and taking all your shit. Our evil plan is working... Hahaha!

To those who say, just pay for your own mammogram if you're going to be a big whiny baby about breast cancer: Well, I can and I will if I have to. I guess women who can't afford it without insurance will just be out of luck... It seems to me that Obamacare will just make rich people pay for their own high-quality care - but they will still be able to get good healthcare. Poor people will be on health-care dregs and rations with the government deciding when they can get treatment.

And I'm a Democrat!... or was, I suppose.

Pogo said...

Michael Hasenstab said of course what is the only important thing about the mammogram debate:
Who decides is determined by who pays.

Consider the idea that all the poor and middle class and upper middle class folks will be owned by the US government.

The rich will still be able to fly elsewhere for special care.

All this data talk is a bullshit sideshow.

Triangle Man said...

Where were all the fretful posts when the USPSTF changed their colon cancer screening recommendations last year, or said that there was no clear benefit for a primary care doc to do skin cancer screening. By gum, they recommend against screening for testicular cancer too! Someone call Lance Armstrong!

Triangle Man said...

Poor people will be on health-care dregs and rations with the government deciding when they can get treatment.

The poor will only get dregs when fiscal conservatives can get back in power and de-fund the programs. The Democrats will then run on improving these services again, and the cycle continues.

Nora said...

I would like to know who paid for the US study that is based on the results from the studies conducted in the two countries with cancer survival rate lower than in the US. In the UK case these are actually significantly lower, being below European averages?

How this study got funding? What their objective were as defined in funding proposal? Saving anxiety? I don't think so.

Darren Duvall said...

@Triangle Man,

Some high-grade, very aggressive DCIS tumors will present with a characteristic pattern of calcifications and we know ahead of time these are nasty little buggers that need to come out.

Even well-differentiated DCIS proven by biopsy is expected to progress to invasive breast cancer in 30-50% of women. It's arguable therefore that 50-70% of women with low-grade DCIS do not need further treatment after a core biopsy proving low-grade DCIS.

The problem arises when trying to stratify those women by risk, there will be some women who are misallocated into the no-treatment arm who later develop an invasive malignancy that threatens their life. I am not aware of a reliable test that can be used to tell women anything other than their 30-50% chance of later development of invasive breast cancer based on their low-grade DCIS -- the majority of which is left in place after a biopsy. I think a test that could determine the risk of progression would be very helpful, if an individual woman's risk was really 5% or really 50%, that would make a huge difference in treatment.

Screening took a long time to catch on, and while the majority of risk reduction seems to be related to not putting everyone on HRT (about 2/3), the rest is believed to be the effect of screening.

@Gabriel

That was not my claim. Someone else said that to me, if you go back and read their post.

Mammography is not the best tool to screen for breast cancer, just the most time-and-cost-effective method that we have.

Mammography does involve radiation, and given enough women getting enough mammograms over their entire lifetimes, some induction of a few cases of malignancy that would otherwise not occur is to be expected. Nothing is without risk, but statements like "mammography is killing people" are pretty much along the lines of "if a cancer is exposed to air it will spread", i.e., statements of ignorance.

If all breast biopsies were done under anesthesia, then the risk of having a breast biopsy comes down to the risks of general anesthesia, which for the 40-49 age group tends to be astronomically low.

As it is, the majority of breast biopsies are done percutaneously under local anesthesia, with a 3mm or smaller incision and needle sizes from 18 to 11 gauge. Losing a patient in that situation is highly, highly improbable. I've been doing breast biopsies for the last 8 years and haven't had so much as a hematoma, much less an infection or death.

Have I caused anxiety? Absolutely. A sharp object in the breast is a scary thing, local anesthesia or no. Being told that "Taking more pictures isn't going to tell us what this is," and that a pathologist needs to be involved is going to invoke anxiety. But I've never had anyone tell me, "Hey thanks for missing that breast cancer last year. Even though I have to go through chemo and radiation, I had a great year last year being ignorant of this thing in my breast that is now trying to kill me."

Der Hahn said...

fls (and others).

Going to a hospital is a good way to get sick and die.

Google 'Hospital Acquired Infection' and do a little reading.

Healthcare-associated infections are a major public health problem. According to the Centers for Disease Control and Prevention (CDC), there were an estimated 1.7 million healthcare-associated infections and 99,000 deaths from those infections in 2002.

For comparison, there were approximately 43,000 fatalities from auto accidents in 2002.

The risk from undergoing medical procedures is not trivial.

Darren Duvall said...

I am very suspicious of meta-analysis, where the results of many studies are combined and (it is hoped) the biases cancel each other out. Doesn't mean they're useless, but it also doesn't mean a meta-analysis is more incisive or closer to the truth than individual studies. There is also the selection bias in which studies are used to create the meta-analysis in the first place.

Screening of the 40-49 age group has been controversial for decades. The current task force recommendations don't materially change that, and more importantly they don't change the laws in the 49 states that require insurance carriers to pay for screening mammograms beginning at age 40. That's going to be a state-by-state level fight, and no insurance company in their right mind is going to try to change the law and fight the Pink Ribbon Brigade in the court of public opinion. One 45 year-old breast cancer survivor is worth a regiment of biostatisticans in that field.

What I see likely to happen is a number of patient education foundations funded by insurance companies sending PSAs that say, "Know Your Risk!" and heavily favor USPTF recommendations over ACR/ACS recommendations. Insurance companies have to pay claims for women 40 and over who have mammograms -- but they don't have to pay claims for eligible women who don't show up for their mammograms.

Gabriel Hanna said...

@Triangle Man:

How about a correlation in a clinical trial?

It doesn't matter if it's in a clinical trial or not. Correlation is not equivalent to causation.

Statistical analysis can tell you two variables are correlated but it cannot tell you WHY. In order to demonstrate causation you have to show some kind of mechanism that connects cause and effect. If I have a pill that clinical trials show that people who take it turn purple at higher rates than people who take the placebo, I still don't know WHAT the pill did, if anything, that made people turn purple. All I can do is try to design the trial so that the pill is the only difference between the two groups.

And when it comes to lifestyle issues like cancer and heart disease and obesity, there is no way you can design a trial that eliminates all effects other than what you are studying. You cannot imprison people for fifty years and control everything they do.

So, when Darren says unnecessary mammograms CAUSE death and cancer, he is saying something false. Clinical trials or no.

Original Mike said...

The real bottom line is that no one is making the decision for you. It's a recommendation from the USPSTF based on the best currently available evidence (including several clinical trials). If it weren't such a serious topic, the hysteria surrounding the recommendation would be hysterical.

If I believed that's all it would stay, a recommendation, and I'd be free to purchase services I feel I need with my own money, I'd be fine with it. But I know, and you know if you have been paying attention lo these many years, it won't stay a recommendation.

Gabriel Hanna said...

@Darren

Sorry, wasn't you. Okay, then whoever said it.

Darren Duvall said...

The poor will only get dregs when fiscal conservatives can get back in power and de-fund the programs.

Like the 'fiscal conservatives' of the Labour Party that currently fund the NHS?

traditionalguy said...

Just in that Palin plans to make poor women use medical duct tape on their breasts as revenge against the McCain campaign. That's the latest revalation from Tina Fey, Katie Couric and Charlie Gibson who have actually read Palin's book. We all know that Palinistas cannot read books themselves.

knox said...

Wake the fuck up, people! The goveernment is about to enslave you, and your are happily dithering with obscure details that help you rationalize that this s a good thing.

Haven't you heard--Everything's "Changed." Dithering is what it's all about now.

traditionalguy said...

Grapp...The prior comment was facetious humor only, using an argument ad absurdum. Princess Palin can take the heat and her defenders need to just hide and watch while she field dresses the Demonrat's carcass.

Fred4Pres said...

What's a few thousand lives if you can save billions of dollars? Plus there is medicare and social security savings you are not factoring in by their early deaths. Win Win.

Shanna said...

Going to a hospital is a good way to get sick and die.

I suspect the majority of the risk is for people who stay overnight, and many if not most of these biopsies and such are outpatient procedures and thus unlikely to result in death.

You know what else is a good way to get sick and die? Cancer.

david7134 said...

At lunch today, I sat in a room full of doctors and this was the topic. They could not believe the announcement of this group. It virtually seals the fate of a large number of women and is completely contray to the cancer institute.

This is socialized medicine that Obama is trying to shove down our throats. Right now it will be used by insurance agenies to refuse payment for exams. Once Obama has his way then it will be mandated and you will not even be able to pay cash to get the procedures preformed.

Thanks Obama. (or is that racist)

AJ Lynch said...

Ditherers were almost extinct! But Dick Cheyney and Prez Obama have saved them from extinction.



wv = facksly [sounds like it should be a word]

AJ Lynch said...

Ditherers can save the economy!

If we all do more and more dithering, we will need to hire more and more people to help with the dithering. That Obama is a genius!

Freeman Hunt said...

Yay! No more icky, uncomfortable treatments for anything!

Don't you like nature? Just let nature decide. Let nature takes its course, whatever that may be.

Nature knows the way!

Thanks, Obama. This is definitely change. Definitely hope too since we'll all be hoping really hard to not get sick.

David said...
This comment has been removed by the author.
David said...

But they are right. Most women do not need mammograms in their 40's. Only the ones with breast cancer get any benefit at all.

Triangle Man said...

It doesn't matter if it's in a clinical trial or not. Correlation is not equivalent to causation.

Certainly saying that "correlation proves causation" is a logical fallacy. From that, it follows that correlation does not necessarily imply causation. However, you seem to be saying that a correlation from a randomized trial does not provide any greater evidence for causation then say a correlation observed in a cross-section of medical records.

Triangle Man said...

and is completely contray to the cancer institute.

No it's not. As pointed out above an NCI consensus panel made a similar recommendation in 1997. That women should make the choice in consultation with their physicians and in the context of their own values and perceptions of the risks and benefits.

kentuckyliz said...

The type and aggressiveness of my cancer wasn't tested and known until I had my surgery and the tissue with the tumor and a margin was sent to the pathologist for testing.

In fact, my surgeon had to go back in and cut more margin for safe clearance, especially with the cancer sending out "irritating infiltrate" to surrounding breast tissue...carcinogenic chemical messages.

HER 2+, vascularized, fast growing, ER+/PR+, highly aggressive.

Mom's breast cancer killed her 4 years after diagnosis.

If I have the same timeline, I have a year and a half left.

Bucket List!

Depending on how the midterm elections go, I may be praying for the sweet release of death anyway. LOL

My BrCa wasn't calcified--I couldn't feel it, neither could my surgeon or oncologist even after it was mapped.

Flat, mushy, soft tumor.

BSE wouldn't catch that. I was doing BSE 2x/month using an expanded routine my thyroid oncologist taught me.

Women who have had thyroid cancer are at greater risk for breast cancer.

Women who have had melanoma are at greater risk for breast cancer.

My genetic tests are negative (BRCA1, BRCA2, PTEN...couldn't swindle a CHK2 test out of my genetic counselor).

BrCa age 42. Surgery/treatment age 42.

ThyCa age 40...permacancer.

Melanoma age 26.

Threat of 4th cancer (large, fast growing, partly solid tumor on ovary) this year, age 43. TG it wasn't cancer. I need a break from all the medical drama.

Anyone responsible for adopting this position on BSE and mommygrams...will find this pink ribbon brigader silently sidling up to them in the dark, wrapping the pink ribbon around their neck, and squeezing tight.

That's what I'm going to do with my pink ribbon.

Here's an alternative proposal to save money to funnel to ACORN nuts:

no coverage for Viagra/Cialis etc.

That's a recreational drug!

BTW there are occasional promotions offering free or cheap mommygrams. Trying to reach the poor and minority people who aren't getting screened, so they have a higher morbidity and mortality rate. Why not improve their screening, instead of insisting that the white women have to increase their morbidity and mortality rates to equalize things racially and socioeconomically?

I thought earlier detection, more advanced and customized treatment options, and higher survival (lowered morbidity and mortality rates) were an achievement.

Apparently it's just a waste of money.

Keep me soaked in Victory Gin and I will learn to love Big Brother...and long for the sweet moment of the bullet in the brain.

kentuckyliz said...

Will ObamaCare cover medical marijuana?

What about medical meth?

Good for weight loss, chronic fatigue syndrome.

LOL

JohnAnnArbor said...

What about medical meth?

Good for weight loss, chronic fatigue syndrome.


And the government's bottom line, if they give you enough of it.

AJ Lynch said...

Good one Michael H! So go that you have become a tag line!

wv = coednest

Triangle Man said...

I'm probably going to botch this because I don't have time to do a proper job, but the census says there are about 21 million women in the US between the ages of 40 and 49. If 100% participated in annual screening, about 1,100 lives would be saved each year (1 death in 1900 screened over 10 years of screening).

Each year there would also be:
22,105 false negatives.
Just over 2 million false positives.
1.76 million added imaging studies
198,936 biopsies
33,156 screened invasive cancers
11,052 screened in situ cancers


That is a lot of lives saved, but an awful lot of other consequences for this population.

c3 said...

Of course, different women may interpret these harms differently and weigh them differently in their decision.

Exactly and that's what every doc should do when discussing breast cancer in a woman under 50.

However, if the mutual decision is to order the mammogram then the question of "who pays" will inevitably come up. so if I've made a "bet" that I'm different than the average risk and I want to get the mammogram what should be my financial stake in that "wager".

BTW I do believe if "market forces" came to bear on this issue you'd see $50 mammograms.

Lem said...

Women don't breast feed anymore. Other than the Hassan's paying to look at them.. What are they good for ;)

Ok.. maybe show them at nude beaches.

wv - fallys

kalmia said...
This comment has been removed by the author.
Pogo said...

Worry not.

The State loves you and only wants the best for you.

BTW, if you come across any blog posts or comments about health insurance reform that seem fishy, or that speak against care recommendations, send it to flag@whitehouse.gov.

Lem said...

Or to each other ;)

Maguro said...
This comment has been removed by the author.
Michael Hasenstab said...

@AJ Lynch - thanks.

Eric said...

No one has ever died from a mammogram.

This is wrong. Mammograms are x-rays. There will be some (hopefully very small) percentage of women who will develop breast cancer every year as a result of a previous mammogram. That's the hazard of x-rays - any kind of x-ray.

Too Many have died from not having a mammogram.

The evidence suggests women (especially in the 40-49 age range) don't actually live longer when they get mammograms. Nobody knows for sure why that is. Most people can think of someone who died from breast cancer after a late detection, but what they can't know is whether she would have still died had the cancer been detected earlier.

And for me it is still too many if it is ONE! What kind of people are we if we look at cost benefit ratios where there will be unnecessary deaths.

That's a child's view of medicine. As a society we already make cost/benefit trade-offs in safety and medical matters on a regular basis. If money were really no object there are all sorts of blood tests and diagnostic scans that would save a few thousand lives every year.

But we don't get those tests because it costs too much. We could, literally, spend our entire GDP on health care if we actually implemented the "one life is too many!" philosophy.

AJ Lynch said...

Pogo:


Don't forget to add "personal & confidential for HHS Scarytary Kathleen Sebelius"!

Govt is Great - Give Us More Rules & Regulations!

Shanna said...

about 1,100 lives would be saved each year (1 death in 1900 screened over 10 years of screening).

At 21mil, don't you mean 11k lives? (It's possible my math is wrong, but I kind of think yours is, considering your false neg was 22k. ) That's a rather significant difference.

kentuckyliz said...

I just channel surfed past some talking head on Jim Lehrer saying that teaching breast self-exam was not efficient use of time and dollars, either.

So, is Viagra covered?

Pogo said...

"As a society we already make cost/benefit trade-offs in safety and medical matters on a regular basis."

That's crap.
There is no "we", and there is no mention of either the Public or Society in the Constitution (cf Hearne).

What you are describing is tyranny by unelected experts, a return to feudalism.

"We" don't make trade-offs at all. I do. You do. At most, my family does, through my wife and me. But "we" never get together, not you and me 'we'.

You're speaking about real issues using metaphors, which is bullshit.

What you mean to say is The Democrats have decided that, the Constitution aside, you no longer have the right to make any decisions about your own body, because we now own it.".

Don't be shy Eric, speak up. Admit it. You and the Democrats want to run our little lives as if we were pets or small children.

former law student said...

The Democrats have decided that, the Constitution aside, you no longer have the right to make any decisions about your own body, because we now own it.".

Pogo, as has been pointed out a few times here, such pronouncements -- "We know better than you," "Don't worry your pretty little heads," all based on "statistics say that, on the average, the cost-benefit blah blah blah" -- arise from arrogant MDs, not Democrats per se.

(did you hear the one about God having an MD complex?)

Eric said...

There is no "we", and there is no mention of either the Public or Society in the Constitution (cf Hearne).

So what? Whole sections of the constitution are regularly ignored by the courts, and that's not going to change any time soon. As a practical matter we, and I do me "we", through our elected representatives, make those trade-offs. We make trade-offs regarding how much lead is acceptable in products, what speed is considered "safe", and yes "we" make medical decisions partially based on cost.

Pogo, you make it sound like the government isn't already heavily involved in health care. It very much is, both because Medicare has a large input in deciding what the accepted standard of care is and because insurance companies are peppered with regulations regarding what must be covered. Hell, insurance companies probably wouldn't cover mammograms at all but for government regulations requiring coverage.

Granted, Obama wants to take it to a whole new level, but it's a change in degree, not in kind.

Michael Hasenstab said...

I just channel surfed past some talking head on Jim Lehrer saying that teaching breast self-exam was not efficient use of time and dollars, either.

So, is Viagra covered?


Teach men to conduct breast exams. Two stones, one bird.

rhhardin said...

Mammograms were early electronic mail sent by women.

wv placcuu, Hawaiian bird of peace.

Triangle Man said...

@Shanna

You are wise to doubt me, but the 1/1900 figure is based on several years of screening. You would see 11,000 lives saved among 21 million women in 10 years, but would have to multiply the harms by 10 too. There are something like 40,000 deaths from breast cancer in the US each year among women if all ages. The false negatives reflect missed diagnoses but not necessarily fatal cases, so there will be many more of them.

Pogo said...

"Granted, Obama wants to take it to a whole new level, but it's a change in degree, not in kind."

It would be well then to finally dispense with the fiction of liberty, the Constitution, or any supposed "we" making decisions and acknowledge out loud that we have lost a democratic republic, and are slouching toward tyranny.

Shanna said...

such pronouncements -- "We know better than you," "Don't worry your pretty little heads," all based on "statistics say that, on the average, the cost-benefit blah blah blah" -- arise from arrogant MDs, not Democrats per se.

On the NYtimes blog, they were blaming "insurance companies" for these new guidelines, but with rare exceptions, pretty much everybody was against the change.

You are wise to doubt me, but the 1/1900 figure is based on several years of screening. You would see 11,000 lives saved among 21 million women in 10 years, but would have to multiply the harms by 10 too.

Fair enough, then shouldn't your 22k false neg's be 2k? I think you used the numbers for 10 years for all your negatives and the yearly number for lives saved.

Eric said...

It would be well then to finally dispense with the fiction of liberty, the Constitution, or any supposed "we" making decisions and acknowledge out loud that we have lost a democratic republic, and are slouching toward tyranny.

Haven't we really already dispensed with the constitution? Not just the particulars, but also the spirit of the document? If Obamacare is unconstitutional, then so is Medicare. And a whole lot of other stuff.

Me, I trace it back to Wickard. That was really the end of the federal government and the beginning of the national government.

blake said...

Crack Emcee to someone who's been shot twelve times: "New Age thinking is the main gunshot wound we need to protect ourselves from!"

Largo said...

Where's Titus?

kentuckyliz said...

@ Hasenstab:

My bf's have always been eager about BOE. Breast Other Exam. (And TOE for that matter--Testicular Other Exam!)

So if the medical perfessionals can't be bothered to teach it, not even some lowly CNA, then it's up to us to teach it and pass it on.

We have to take matters into our own hands!

Michael Hasenstab said...

@kentuckyliz - yeah, it's for the cause. Great idea!

What color is the ribbon?

Joking aside, that method did lead to discovery of a lump that wife's MD had missed.

And not a "foolin' around" partner exam, but a genuine, thorough and careful twice monthly exam we began out of concern for the lack of thoroughness in a 10 minute physician encounter.

Pogo said...

"out of concern for the lack of thoroughness in a 10 minute physician encounter."

Too true.
Medicare right now pays for 45 minutes of my time for a "general physical" (which, BTW, the selfsame USPSTF guidelines do not recommend either) in which by law I am required to document at least 4 "elements of recent history", from 10-14 system review questions, family and social history, and examine 8-12 organ systems, then document these plus multiple numbered impressions, review of tests, and plan of care.

For all that, Medicare will pay me $130 (minus discounts and clawbacks and maybe actually received 3-6 months later).

This fee will decline 20% as of 2010. The optimal visit from a pay perspective is now less than 15 minutes total. No breast exams for you.

Women, you are on your own, it appears, and simply not worth it, to the gummint anyway.

c3 said...

Pogo;
I assume by your comments that you're a physician. If so then its curious that you've invoked the constitution in what appears to be a discussion (later on) about how much you get paid versus how much you feel you should be paid.

The USPSTF is not a "big brother" agency restricting the rights of individual to purchase the healthcare they desire. It was asked "Does the evidence support this intervention?" In the case or ROUTINE mammograms for women under 50 they've concluded "no"

Will that ban doctors from still recommending them? NO
Will that prevent insurance companies from paying for them? NO
Would that outlaw the right of an under-50 woman to "buy" a mammogram on the open market? NO

PS: The USPSTF made similar recommendations about other tests under Clinton and Bush. Its not a conspiracy.

k*thy said...

1. My reading of the USPSTF statement is a recommendation that doctors be honest with patients about the limitations of early mammograms and the possible down sides and then let women choose. Why is offering choice, discussion, and information bad?

2. For those who are concerned that these recommendations may lead to lack of insurance coverage for early mammograms, be sure to think carefully about whether there is any limit to the dollar amount of tax increase or health insurance premium increase you personally are willing to accept in order to make sure that each and every woman in the country has the same access that you want for yourself or your family.

Pogo said...

" its curious that you've invoked the constitution in what appears to be a discussion about how much you get paid versus how much you feel you should be paid"
Curious?
In what way?.

"The USPSTF is not a "big brother" agency restricting the rights of individual to purchase the healthcare they desire."
Not now.
In nationalized healthcare, that is EXACTLY what they WILL do.

Will that ban doctors from still recommending them?
NO, BUT SOON, IT WILL.

Will that prevent insurance companies from paying for them? NO, BUT IT WILL ALLOW THEM TO DO SO.

Would that outlaw the right of an under-50 woman to "buy" a mammogram on the open market? NO, AT LEAST, NOT YET. AND TOO BAD FOR YOU POOR WIMMENS. TOUGH LUCK, EH?

Its not a conspiracy.
NO, BUT IT IS STATISM, PRACTICED WIDE OPEN, UNCONCEALED.

Seriously, what makes you believe those restrictions won't unfold here just like they have in every other nation with nationalized medical care?

Triangle Man said...

Pogo, are you going to recommend annual screening mammograms to your female patients aged 40 - 49?

Pogo said...

We were told: "Based on a preliminary review of the Annals of Internal Medicine screening mammography papers ..., it is advised that [we] continue with current recommendations for screening mammography at this time (which is to continue to offer screening mammography for women 40 and older). This guidance takes into consideration screening guidelines currently in place at other agencies such as the American Cancer Society. The National Cancer Institute is taking a "wait and review" approach."

c3 said...

Pogo;
As I've seen before, all evidence against a conspiracy theory simply re-inforces the conspiracy sentiment.
That's what they want you to think!

PS Keep trying with the "WIMMENS attack because, of course, anyone who would support Nationalized Health Care (which I don't) would want to oppress women.

Pogo said...

Christ, c3, this is exactly how care is currently being delivered in socialized medicine in other countries.

Why do you think it would differ here?

And what conspiracy do you keep harping on?
It's hardly a conspiracy when nationalized health care has been the stated and acknowledged goal of the Democratic Party.

Criminey. What the hell are you even talking about?

Triangle Man said...


Fair enough, then shouldn't your 22k false neg's be 2k? I think you used the numbers for 10 years for all your negatives and the yearly number for lives saved.


@Shanna

The "consequences" presented in the paper and in my post are per year of screening. There would be 2 false negatives per 1,900 women screened per year. False positives etc. are more common than death from breast cancer.

c3 said...

Pogo;
this is exactly how care is currently being delivered in socialized medicine in other countries.
Criminey. What the hell are you even talking about?


The USPSTF came into being under that evil Democratic regime of Ronald Reagan (1984)

This pernicious Democratic conspiracy has survived through the Republican administrations of Bush I and Bush II....clearly part of the long-term plan to now spring their evil Socialized medicine on a naive and unsuspecting public.

Devious....(brilliant) but still devious.

ben said...

MediaCurves.com conducted a study among 600 about the new guidelines released by the Preventive Services Task Force of the Department of Health and Human Services recommending against regular mammography tests for women under 50 years old. Results found that the majority of physicians (78%) reported that they do not agree with the new guidelines. Furthermore, the majority of physicians (78%) also reported that the advice they give to patients will not change based on the new Preventive Services Task Force of the Department of Health and Human Services guidelines.
More in depth results can be seen at:
https://www.mediacurves.com/HealthCare/J7646-MammogramGuidelines/Index.cfm
Thanks,
Ben

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