Experts question motives of mammogram guidelines

RightinNYC · 11-16-09, 10:49 PM

Experts question motives of mammogram guidelines | Health | Reuters

Quote:

Cancer experts fear new U.S. breast imaging guidelines that recommend against routine screening mammograms for women in their 40s may have their roots in the current drive in Washington to reform healthcare.

...

* Dr Carol Lee, chairwoman of the American College of Radiology Breast Imaging Commission, said she fears insurers -- both private and public -- will use them to pare back health costs.

"These new recommendations seem to reflect a conscious decision to ration care," Lee said in a statement.

She said since the onset of regular mammogram screening in 1990, the death rate from breast cancer, which had been unchanged for the preceding 50 years, has decreased by 30 percent.

* Dr Len Lichtenfeld, deputy chief medical officer of the American Cancer Society, said the influential group will not change recommendations for routine mammograms for women starting at age 40.

...

* Lichtenfeld and other doctors are worried that insurance companies and government insurers will seize on the recommendations as a way to control rising health costs.

"What is going to happen is insurers are going to say, 'The U.S. Preventive Services Task Force doesn't support screening. We're not going to pay for it,'" said Dr Daniel Kopans, professor of radiology at Harvard Medical School and a senior radiologist at Massachusetts General Hospital in Boston.

"There were no new data to assess. One has to wonder why these new guidelines are being promulgated at a time when healthcare is under discussion and I am afraid their decision is related to saving money rather than saving lives," Kopans said.

I'm all for cutting back on care that isn't cost-efficient, but the timing of this move really does make you wonder whether the new guidelines were influenced by something other than science.

jackalope · 11-16-09, 10:56 PM

Quote:

Originally Posted by RightinNYC

Experts question motives of mammogram guidelines | Health | Reuters

I'm all for cutting back on care that isn't cost-efficient, but the timing of this move really does make you wonder whether the new guidelines were influenced by something other than science.

If there was no new data to assess, as the article stated, then yes, it does make you wonder whether the new guidelines were promulgated for a reason other than science.

1069 · 11-16-09, 10:57 PM

As far as I know, this recommendation has been in the works for some time.
For the past several years at least, there's been no consensus within the medical community on when mammograms should start.
There are a couple of issues here:

1. Each mammogram raises one's risk of cancer slightly.

2. Breast cancer under age 50 is rare.

3. Before menopause, mammograms are unlikely to detect cancer, because there is a lot of fibroid tissue in pre-menopausal breasts that makes it difficult if not impossible to detect tumors with a mammogram.

So, these ideas have been kicked around for some time. The debate has been going on for years.
I think a lot of experts in the field are now beginning to lean more toward routine mammograms only after age 50.
That does not mean no mammograms ever for women under 50.
It just means that it depends upon the circumstances.
For many women under 50, mammograms would be of little benefit, and the slight risk these women incurred from undergoing mammograms unnecessarily would not be justified.

I personally do not plan to have my first mammogram until I'm 50.

jackalope · 11-16-09, 11:01 PM

Pretty interesting, Ten.

RightinNYC · 11-16-09, 11:15 PM

Quote:

Originally Posted by 1069

As far as I know, this recommendation has been in the works for some time.
For the past several years at least, there's been no consensus within the medical community on when mammograms should start.
There are a couple of issues here:

1. Each mammogram raises one's risk of cancer slightly.

2. Breast cancer under age 50 is rare.

3. Before menopause, mammograms are unlikely to detect cancer, because there is a lot of fibroid tissue in pre-menopausal breasts that makes it difficult if not impossible to detect tumors with a mammogram.

So, these ideas have been kicked around for some time. The debate has been going on for years.
I think a lot of experts in the field are now beginning to lean more toward routine mammograms only after age 50.
That does not mean no mammograms ever for women under 50.
It just means that it depends upon the circumstances.
For many women under 50, mammograms would be of little benefit, and the slight risk these women incurred from undergoing mammograms unnecessarily would not be justified.

I personally do not plan to have my first mammogram until I'm 50.

More info from the report:

Quote:

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 74, and one death for every 377 women age 60 to 69.

It appears that it's unquestioned that mammograms prevent cancer deaths. The task force apparently concluded that the benefits of saving 1 death per 1,339 women outweighed the costs/risks of the procedure, but saving 1 death per 1,904 women is not enough.

Quote:

But the new guidelines are expected to alter the grading system for health plans, which are used as a marketing tool. Grades are issued by the National Committee for Quality Assurance, a private nonprofit organization, and one measure is the percentage of patients getting mammograms every one to two years starting at age 40.

That will change, said Margaret E. O’Kane, the group’s president, who said it would start grading plans on the number of women over 50 getting mammograms every two years.

The message for most women, said Dr. Karla Kerlikowske, a professor in the department of medicine, epidemiology and biostatistics at the University of California, San Francisco, is to forgo routine mammograms if they are in their 40s.

http://www.nytimes.com/2009/11/17/health/17cancer.html

Just doing some (very) rough calculations:

There are 22 million women between the ages of 40-49. Currently, approximately 65% of women in this age group (14.3 million) get regular mammograms. Using the above numbers, that means that over the 10 year screening period, 7,510 deaths are prevented because of those mammograms.

1069 · 11-16-09, 11:28 PM

Quote:

It appears that it's unquestioned that mammograms prevent cancer deaths. The task force apparently concluded that the benefits of saving 1 death per 1,339 women outweighed the costs/risks of the procedure, but saving 1 death per 1,904 women is not enough.

That's not the issue.
The issue is that mammograms raise the risk of breast cancer slightly; each consecutive mammogram raises it more.
Routine mammograms on all women beginning at age 40 may well cause more than "1 death per 1339 women". It might cause 2 or 3 deaths per thousand, for all we know.
If so, recommending that routine mammograms not begin until age 50 is saving lives.

Who GETS breast cancer more often?
Affluent white women. Read the national stats.
Who do you think is most likely to begin early routine mammograms?
Gee, I dunno... could it be affluent white women?

RightinNYC · 11-16-09, 11:44 PM

Quote:

Originally Posted by 1069

That's not the issue.
The issue is that mammograms raise the risk of breast cancer slightly; each consecutive mammogram raises it more.

I don't think there's actually conclusive evidence to support this. The closest thing I've found is a study saying that mammograms may increase the risk of breast cancer in women with the BRCA gene.

Quote:

Routine mammograms on all women beginning at age 40 may well cause more than "1 death per 1339 women". It might cause 2 or 3 deaths per thousand, for all we know.
If so, recommending that routine mammograms not begin until age 50 is saving lives.

Presumably the panel took that into account when it "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 74, and one death for every 377 women age 60 to 69."

If the risk were anywhere near as large as you're suggesting, it wouldn't make sense for the procedure to be worthwhile to save 1/1,339 but not 1/1,904. Furthermore, since the panel excludes women with the BRCA gene from its new guidelines, I don't see how this proposal will affect them at all.

1069 · 11-17-09, 12:17 AM

Quote:

I don't think there's actually conclusive evidence to support this. The closest thing I've found is a study saying that mammograms may increase the risk of breast cancer in women with the BRCA gene.

A mammogram is an x-ray of the breast.
"Routine" annual mammograms beginning at age 40 means that by the time a woman's 50, she's had that breast x-rayed ten times.
By the time she's 70, thirty or more times.
It's a x-ray, for cripe sake. "No conclusive evidence"?
Are you f'ing kidding me?

Each mammogram exposes the breast to more radiation; the effect is cumulative.

American · 11-17-09, 12:22 AM

Quote:

Originally Posted by 1069

As far as I know, this recommendation has been in the works for some time.
For the past several years at least, there's been no consensus within the medical community on when mammograms should start.
There are a couple of issues here:

1. Each mammogram raises one's risk of cancer slightly.

2. Breast cancer under age 50 is rare.

3. Before menopause, mammograms are unlikely to detect cancer, because there is a lot of fibroid tissue in pre-menopausal breasts that makes it difficult if not impossible to detect tumors with a mammogram.

So, these ideas have been kicked around for some time. The debate has been going on for years.
I think a lot of experts in the field are now beginning to lean more toward routine mammograms only after age 50.
That does not mean no mammograms ever for women under 50.
It just means that it depends upon the circumstances.
For many women under 50, mammograms would be of little benefit, and the slight risk these women incurred from undergoing mammograms unnecessarily would not be justified.

I personally do not plan to have my first mammogram until I'm 50.

I plan to offer breast exams for free to help lower healthcare costs.

Kal'Stang · 11-17-09, 01:41 AM

The OP's link didn't mention it but here's another one that does...

Quote:

For years, mammograms have been recommended every year or two for women beginning at age 40. The new report from the U.S. Preventive Services Task Force, issued Monday night, now says women this age should simply talk to their doctors about the benefits and risks. The group also says there's no benefit to performing breast self-exams. The recommendations, which help shape how doctors practice, don't affect women at high risk, such as those with strong family histories of cancer.

USA Today

I wish that all the news sites that I've seen talk about this would explain the part in bold more. I can see no reason what so ever for them to be saying the part in bold.

11-16-09, 10:57 PM	#3
1069 ex nihilo Join Date: Oct 2006 Last Seen: Today 11:05 AM Posts: 19,883 Thanks: 5,797 Thanked 3,914 Times in 2,592 Posts Total Awards: 2	Re: Experts question motives of mammogram guidelines As far as I know, this recommendation has been in the works for some time. For the past several years at least, there's been no consensus within the medical community on when mammograms should start. There are a couple of issues here: 1. Each mammogram raises one's risk of cancer slightly. 2. Breast cancer under age 50 is rare. 3. Before menopause, mammograms are unlikely to detect cancer, because there is a lot of fibroid tissue in pre-menopausal breasts that makes it difficult if not impossible to detect tumors with a mammogram. So, these ideas have been kicked around for some time. The debate has been going on for years. I think a lot of experts in the field are now beginning to lean more toward routine mammograms only after age 50. That does not mean no mammograms ever for women under 50. It just means that it depends upon the circumstances. For many women under 50, mammograms would be of little benefit, and the slight risk these women incurred from undergoing mammograms unnecessarily would not be justified. I personally do not plan to have my first mammogram until I'm 50.

11-16-09, 11:01 PM	#4
jackalope Sage Join Date: Jul 2009 Last Seen: 02-12-10 07:42 AM Posts: 6,300 Thanks: 3,354 Thanked 1,275 Times in 889 Posts Lean: Liberal	Re: Experts question motives of mammogram guidelines Pretty interesting, Ten.

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