१६ एप्रिल, २०१५
"While I think the intent of these laws is well meaning, I think their impact is going to be a significant problem, where we end up doing more harm than good."
That's a comment that could apply to an awful lot of things, but in this case, it's a doctor commenting on laws that require women to be notified that they have dense breasts.
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Thank God I'm retired. California has been legislating health care for decades. When I was still in practice, the legislature passed a law that we had to offer simple mastectomy as an option for women with cancer. I was already doing it but I was pleased that the liability was assumed by the state. If some woman had recurrence after a simple mastectomy or "lumpectomy" I could say, "It's the law !"
I always told women about dense breast tissue,which is usually in younger women. I've seen quite a few cancers with negative mammograms. Thats where a surgeon's experience comes into play.
Breast surgeons are all women now anyway. One of my good students is doing that training now.
Laslo, call your office.
Why would there need to be a law for that? What is it about some people who think that there needs to be all sorts of laws for everything under the sun? Do we not have enough laws? Is there a severe paucity of rules, regulation, and legislation in this country?
First we make a law that all women must be given free mammograms.
Then we make a law that women must be informed that in spite of the first law they may still die.
Have I got it right?
It's a way to make insurance companies pay for screening breast MRIs.
Slippery slope.
First breast density.
Then brain density.
My doctor has repeatedly served me with notice that I have a thick skull.
Combine that with dense head tissue and lots of publicity of "celebs" having their breasts and uteruses (uteri?) removed, and it ought to make for a small boom in the hospital meat-cutting industry.
sydney's remark about insurance, and Michael's about liability, seem right to me. With the CA legislature, though, you can be sure of two things: 1) there's at least one hidden agenda, and 2) there will be unexpected consequences.
My (not-young) wife has this issue, and sometime has to hunt around a bit for an imaging clinic that understands it. However, we live in the SF bay area, so that's no burden for us. IIRC, her doc was the one who explained the situation and the diagnostic issues to her, many moons ago.
Insurance, OTOH, is always a pain, mainly because of the different policies (and confusing coverage codes) around normal "diagnostic" items and costs, vs. "treatment" type things. (That's a bit vague, but the gist is right, and anyway she's in San Diego today so I can't just ask her over morning coffee.)
"First we make a law that all women must be given free mammograms.
Then we make a law that women must be informed that in spite of the first law they may still die.
Have I got it right?
Perhaps they should also be informed if the risk of contracting cancer due to the ionizing radiation used in the diagnostic procedure is greater than the increased risk of death if they don't have that diagnostic procedure?
They are revisiting abortion policy. Perhaps in an effort to reconcile the rights of a woman vs the rights of her wholly innocent child. With more people rejecting the pseudo-scientific theory of "spontaneous conception" and the pro-choice or selective doctrine, this review is long overdue.
While I think the intent of the law is well-meaning...
If you have to use the phrase, the law you're talking about is probably bad.
Ambiguous factors are likely to increase abuse of preemptive therapies with the miscommunication or misinterpretation of individual risk. As well as increasing stress that may be pose a greater risk to individual and group (e.g. husband, children) health than originally assessed.
Thanks. I'm adding that to my list of Things We Don't Need a Law About.
(Legislators grade themselves on how many laws were passed during the session. I grade them on how many laws were repealed. Why I never vote for the incumbent.)
The worst cancers are often those with normal mammograms because the findings on mammogram are usually the body's immune response. No immune response, no findings.
No, this law is Good! It's just information sharing; and presumably these ladies will want to update their Tinder profiles accordingly.
Mammography is, by an astronomically wide margin, the most heavily regulated field of medicine. Under the Mammography Quality and Safety Act, there is far more government oversight and tedious required paperwork than there is for brain surgery, heart surgery, pediatric oncology, child psychiatry, or any other medical specialty. Half of the verbiage in a mammogram report is put there to satisfy the express regulatory orders of the FDA and state regulatory bodies, especially in California.
By contrast, there is essentially no Federal regulation of prostate cancer diagnosis and treatment, apart from some generally applicable rules on handling radiation sources, even though it affects roughly the same number of men as breast cancer does women.
Gee. What on earth could account for the difference?
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