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Experts question motives of mammogram guidelines

rivrrat said:
It's not just about the mammograms. They actually said women shouldn't be doing self-breast exams!!! That is patently INSANE.
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I don't think that is correct.

What they said is that there is no point in having the physician teach breast exam techniques. I find this a really short sighted confusing statement, too, but what I gather is that they encourage women to know their bodies and check their breasts in the shower etc. They want women to have a yearly breast exam from a professional.
Breast cancer is the leading cause of cancer death for women. The LEADING cause. Are some of you not getting this? And the government (and apparently some of you) are more worried about some false positives than actually catching the disease? How many false positives come out of pap smears? Quite a few I'd reckon since I've had several myself. But I would rather have 100 false positives than miss that ONE true positive.
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No one will stop you from having one if that is what you want. I am in the high risk category and I am convinced they are not much good and may be harmful.
 
After reading through the first 3 pages, here's my 2-cents worth (which might not be worth a damn since...well, I'm a guy)...

I'm sure this new "guidelines" on mammograms is directly related to the health care reform issue and will certainly translate to fewer mammograms being covered under insurance, but I also believe that enough legitimate research has been done on the matter to warrant a reduction in mammograms for specific age groups among women. This translates to fewer unnecessary tests/screenings that have the potential to do more harm than good and probably don't change the rate of breast cancer detection substaintially enough to warrant performing the test in the first place.

Now, if you want to call this rationing health care, so be it. I'd prefer to call it being responsible. So, women under 40, my recommendation (which I've also discussed w/my wife and daughters) is if feel you don't need to have a mammogram done, then don't do it. However, I'd highly recommend exercising caution and still perform self-exams especially if (the women in) your family has a history of (breast) cancer.
 
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Objective Voice said:
After reading through the first 3 pages, here's my 2-cents worth (which might not be worth a damn since...well, I'm a guy)...

I'm sure this new "guidelines" on mammograms is directly related to the health care reform issue and will certainly translate to fewer mammograms being covered under insurance, but I also believe that enough legitimate research has been done on the matter to warrant a reduction in mammograms for specific age groups among women. This translates to fewer unnecessary tests/screenings that have the potential to do more harm than good and probably don't change the rate of breast cancer detection substaintially enough to warrant performing the test in the first place.

Now, if you want to call this rationing health care, so be it. I'd prefer to call it being responsible. So, women under 40, my recommendation (which I've also discussed w/my wife and daughters) is if feel you don't need to have a mammogram done, then don't do it. However, I'd highly recommend exercising caution and still perform self-exams especially if (the women in) your family has a history of (breast) cancer.
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No, because raising the minimum age for routine mammograms has been discussed and debated for years; I think I first heard about the controversy six years ago.
It's just that more and more, women under 40 are being subjected to a lot of unnecessary, invasive, and disfiguring treatment for issues that wouldn't have caused any problem and would've eventually- after menopause- resolved on their own.
It's a matter of over-screening and overaggressive treatment.
Many people, including some of the top medical experts in the country, have decided that it's not worth it. Even if it save one life per 10,000, it's just not worth the unnecessary havok it wreaks on hundreds and hundreds of other young lives.
As I previously stated, premenopausal breasts are typically full of dense, fibrous tissue, making it difficult for a mammogram to detect tumors even if they're there... but causing a lot of "masses" to show up on x-ray, which doctors then feel obligated to biopsy, when in fact these are merely cysts or areas of dense tissue and entirely normal- practically universal- in young women of childbearing age.

Routine mammograms in women over 50 save lives.
There's simply not much evidence whatsoever to support the idea that routine, yearly mammograms in women under 50 save lives.
If a young woman is in a high risk group or has some sort of troubling symptom, then she should and will have access to mammogram screening.

Also, depressingly enough, it is now coming to light that manual breast self-exams do nothing to aid in the detection of tumors or save lives.
I'm talking about statistics here.
Anecdotally, a beloved mentor of mine found a lump the size of a pea in her breast while taking a shower a few years ago. I posted about this at the time it happened. It was cancer; she underwent treatment.
She wasn't able to beat it, though; it metastasized, and I just heard last week that she's not expected to live until Christmas.
She was in her 40s at the time she discovered the lump.
So, anecdotally, I guess we can chalk that one up to "found cancer via breast self-exam"; statistically, however, her case supports the idea that self-exams are worthless as a diagnostic/ screening tool, because it did not save her.
The cancer was already well-advanced by the time she felt the lump.
 
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Here's a pretty good article about it, just came out today in the Wall Street Journal:

In Cancer Testing, Less Is Now Better - WSJ.com

And here's another, related issue; the American College of Gynecology and Obstetrics- the leading authorities of women's health- are now suggesting postponing cervical cancer screening until a later age, and having less frequent cervical cancer screening.
The group no longer recommends annual PAPs for most women.

Doctor's Group: Delay Pap Tests Until 21

I think the whole mammogram controversy stems partly out of this: it has been indisputably proven that early and frequent cervical cancer screening didn't save lives, and led to overaggressive and unnecessary invasive treatment, sometimes leaving healthy young women unable to bear children, when in fact no treatment was needed. Mild dysplasia (abnormal cell changes in the cervix) is so common as to be practically universal in adolescent girls, usually due to hormonal changes or infections. It typically- in nearly all cases involving very young women- clears up on its own within 6 to 18 months, without treatment.

Women are overscreened and overtreated in this country. In other industrialized nations, recommendations for later PAPs at intervals of 3 to 5 years are the norm, and in these countries the rates of cervical cancer are no higher than ours, although their rates of aggressive treatment of common, benign, potentially "precancerous" conditions of the cervix are much less.

Testicular cancer is a fairly common cancer, more common in young men than in older ones. It is, in fact, more common than cervical cancer, in the industrialized world.
Yet nobody's recommending that all young men- beginning in adolescence- report to the doctor for annual testicular cancer screenings, where the testes are examined via ultrasound, and any suspicious areas biopsied.
These screenings are done only if there's some problem or symptom, or if the patient requests it.
 
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1069 said:
No, because raising the minimum age for routine mammograms has been discussed and debated for years; I think I first heard about the controversy six years ago.
It's just that more and more, women under 40 are being subjected to a lot of unnecessary, invasive, and disfiguring treatment for issues that wouldn't have caused any problem and would've eventually- after menopause- resolved on their own.
It's a matter of over-screening and overaggressive treatment.
Many people, including some of the top medical experts in the country, have decided that it's not worth it. Even if it save one life per 10,000, it's just not worth the unnecessary havok it wreaks on hundreds and hundreds of other young lives.
As I previously stated, premenopausal breasts are typically full of dense, fibrous tissue, making it difficult for a mammogram to detect tumors even if they're there... but causing a lot of "masses" to show up on x-ray, which doctors then feel obligated to biopsy, when in fact these are merely cysts or areas of dense tissue and entirely normal- practically universal- in young women of childbearing age.

Routine mammograms in women over 50 save lives.
There's simply not much evidence whatsoever to support the idea that routine, yearly mammograms in women under 50 save lives.
If a young woman is in a high risk group or has some sort of troubling symptom, then she should and will have access to mammogram screening.

Also, depressingly enough, it is now coming to light that manual breast self-exams do nothing to aid in the detection of tumors or save lives.
I'm talking about statistics here.
Anecdotally, a beloved mentor of mine found a lump the size of a pea in her breast while taking a shower a few years ago. I posted about this at the time it happened. It was cancer; she underwent treatment.
She wasn't able to beat it, though; it metastasized, and I just heard last week that she's not expected to live until Christmas.
She was in her 40s at the time she discovered the lump.
So, anecdotally, I guess we can chalk that one up to "found cancer via breast self-exam"; statistically, however, her case supports the idea that self-exams are worthless as a diagnostic/ screening tool, because it did not save her.
The cancer was already well-advanced by the time she felt the lump.
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Sorry to hear about your friend! Are you in a medical field? In retrospect, I wish I had looked at my mother's medical records and asked many more questions. She had breast cancer, then colon cancer and finally kidney cancer. The whole experience was extremely surreal because the first sign that she was sick, again, was that became unbearably atypically depressed. They did tests and gave her an M.R.I. -or was it a Cat scan?- anyway they found nothing, initially. Months went by before they found cancer again and started pumping her with chemo.

What I understand is that neither breast nor colon cancer typically metasticizes to the kidney. My suspicion is that all of the chemo and radiation she received for the first two cancers, set her up for a brand new cancer. Sorry for the digression but I am convinced that the way we have been screening for and treating cancer will one day look to us the way bloodletting does, today.
 
underdog334 said:
The reccommendation was based on a cost-benefit analysis,which means that the panel had to arrive at the dollar value of a woman's life.
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No it wasn't.

There was no consideration of cost whatsoever.

The only consideration was risk of undetected breast cancer vs. risk associated with mammograms. Pure science.
 
apdst said:
The rationing begins.
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1. Rationing happens all the time, even in private insurance. Can you go get any test you want as often as you want and get it covered? No. You can't get a mammogram once a month paid for by your insurance, even if you or your doctor thought it was necessary. Stop pretending like rationing doesn't already happen. We don't have unlimited resources.

2. This panel is merely making a medical judgement. It has no enforcement power.
 
misterman said:
1. Rationing happens all the time, even in private insurance. Can you go get any test you want as often as you want and get it covered? No. You can't get a mammogram once a month paid for by your insurance, even if you or your doctor thought it was necessary. Stop pretending like rationing doesn't already happen. We don't have unlimited resources.

2. This panel is merely making a medical judgement. It has no enforcement power.
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In the words of Joe Wilson....YOU LIE!

It is in the bill, it was discussed on This Week, and is in the bill, but keep telling yourself this, if it makes you sleep better at night. :shrug:
 
Jackboot said:
In the words of Joe Wilson....YOU LIE!

It is in the bill, it was discussed on This Week, and is in the bill, but keep telling yourself this, if it makes you sleep better at night. :shrug:
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If you're going to call me a liar, you damn well better post the exact language where you think it's in the bill, with a page number.

You can find the full text of the bills here: THOMAS (Library of Congress)

If you don't, that makes YOU the liar.
 
yea this is obviously a pretty loaded subject which all kinds of assertions could be made.

Its only a recommendation.But getting a false positive is no fun.It doesent includes in high risk groups.Generally though its hundreds of biopsys for one life saved.

As for the self breast exam it appears that it just doesent work.
 
mikhail said:
yea this is obviously a pretty loaded subject which all kinds of assertions could be made.

Its only a recommendation.But getting a false positive is no fun.It doesent includes in high risk groups.Generally though its hundreds of biopsys for one life saved.

As for the self breast exam it appears that it just doesent work.
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It is only a recommendation now, but if and when the public option should pass, these recommendations will have the force of law behind them.
 
mikhail said:
yea this is obviously a pretty loaded subject which all kinds of assertions could be made.

Its only a recommendation.But getting a false positive is no fun.It doesent includes in high risk groups.Generally though its hundreds of biopsys for one life saved.

As for the self breast exam it appears that it just doesent work.
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It does not work in every case but it DOES work - I found a breast lump that way. It was benign but it was a lump. Didn't need a biopsy either - had a mammogram and an ultrasound - they even got one of the radiologists in while the ultrasound was happening - his comment- "just some fatty tissue" - is extreme embarrassment a negative outcome??

You are the one who knows your body best - you should be examining it regularly - and for the gentlemen that includes testicular self examination
 
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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.
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If it takes you more than one second to figure this out you are showing mental feebleness or incapacity.
 
Councilman said:
If it takes you more than one second to figure this out you are showing mental feebleness or incapacity.
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If you have made you mind up in less than one second then you do not know all of the facts
 
bowerbird said:
It does not work in every case but it DOES work - I found a breast lump that way. It was benign but it was a lump. Didn't need a biopsy either - had a mammogram and an ultrasound - they even got one of the radiologists in while the ultrasound was happening - his comment- "just some fatty tissue" - is extreme embarrassment a negative outcome??

You are the one who knows your body best - you should be examining it regularly - and for the gentlemen that includes testicular self examination
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Well not really the arent saying you shouldnt go to the doctors if you notice a change.They are just saying its very difficult to examine oneself and statistically doesent help.

Your example just seems to show you getting worried about nothing.I know it seems counterintuitive but what they are saying does make sense.
 
Jackboot said:
It is only a recommendation now, but if and when the public option should pass, these recommendations will have the force of law behind them.
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Well if you choose the public option for yourself and even then its only one health test out of 100s,and in a government backed programme maybe they wont put you through every test in fear of being sued
 
Jackboot said:
It is only a recommendation now, but if and when the public option should pass, these recommendations will have the force of law behind them.
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Wrong. Completely and totally wrong.
 
The problem is that people expect insurance to pay for routine procedures. When I hit 40 I'll decide for myself if I want yearly (or monthly for that matter) mammograms but I would not expect insurance (if I had it which I won't) to pay for it.

If Insurance covered only the unexpected, women could decide the cost-benefit for themselves and the government and insurance companies would not really care. The price would also drop drastically.

.
 
One of the main reasons for the high prices in health care today is the abuse of the system. The idea that you can go to the doctor for a 20 dollar co-pay, this was not what insurance was supposed to be about. If we would pony up for our simple office visits, young and old, think of all the money that we would save. If insurance was treated as it should be, insurance against a cancer, or an extreme injury, the money would be there for all concerned.

This is like expecting your car insurance company to pay for four new tires!:doh
 
Jackboot said:
One of the main reasons for the high prices in health care today is the abuse of the system. The idea that you can go to the doctor for a 20 dollar co-pay, this was not what insurance was supposed to be about. If we would pony up for our simple office visits, young and old, think of all the money that we would save. If insurance was treated as it should be, insurance against a cancer, or an extreme injury, the money would be there for all concerned.

This is like expecting your car insurance company to pay for four new tires!:doh
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The problem is that such insurance is unavailable. The policy I would prefer to buy is one that would cover all of any emergency. I will pay for screening and elective care. I will go to Thailand for any nonemergency elective surgery. Major medical policies that exist in my state are expensive and have such large co-pays that even after meeting the deductible a person may incur large debts. It is criminal.
 
Cassandra said:
The problem is that such insurance is unavailable. The policy I would prefer to buy is one that would cover all of any emergency. I will pay for screening and elective care. I will go to Thailand for any nonemergency elective surgery. Major medical policies that exist in my state are expensive and have such large co-pays that even after meeting the deductible a person may incur large debts. It is criminal.
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Should we return to a sensible use of health care insurance, these plans would be available, and prices would indeed come down. Now don't get too excited, these things will still cost you, real money, nothing is free, nor should it it be, especially if it is the best care. This is yet another reason to allow for people to buy across state lines, the larger the pot, the more there is to access in the case of a real emergency. In that same vein, the larger the pot, the cheaper the rates, and this should be on a sliding scale. If you are a worthless fat ass, you smoke three packs a day, and drink a bottle of vodka a night, you should pay more, this only makes sense.

Problem in this ignorant country, we seem to think everything has to be "fair", whatever the hell that means? Is it fair I work all day, do all the right things, and the crack smoking, beer drinking criminal gets the bed next to me in the hospital?

The country is upside down, and we are only moving further in that direction with this insane new "public option", some people should die in the street, hell, put it on television every night!
 
Jackboot said:
Should we return to a sensible use of health care insurance, these plans would be available, and prices would indeed come down. Now don't get too excited, these things will still cost you, real money, nothing is free, nor should it it be, especially if it is the best care. This is yet another reason to allow for people to buy across state lines, the larger the pot, the more there is to access in the case of a real emergency. In that same vein, the larger the pot, the cheaper the rates, and this should be on a sliding scale. If you are a worthless fat ass, you smoke three packs a day, and drink a bottle of vodka a night, you should pay more, this only makes sense.
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An insurance product that cuts out the overpriced U.S. system for 80% of care, would not be expensive if it existed. Such policies are unavailable because lobbyists have made certain that Americans are prisoners of the existing extortion racket. Why should I pay $175. for 1 month of Advair when it is sold in other countries for $30.? Why should I buy insurance that covers U.S. priced surgery when I can go elsewhere and buy the service for 1/10 the price? Why not send medicaid /medicare patients to India for care if they are fit to travel?

Problem in this ignorant country, we seem to think everything has to be "fair", whatever the hell that means? Is it fair I work all day, do all the right things, and the crack smoking, beer drinking criminal gets the bed next to me in the hospital?

The country is upside down, and we are only moving further in that direction with this insane new "public option", some people should die in the street, hell, put it on television every night!
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Cannot agree with you there. The public option is an anemic, pitiful attempt to help the self-employed (like me) obtain reasonably priced insurance. As currently conceived, it will do little to spark competition for the H.Insurance mafia.
 
Cassandra said:
An insurance product that cuts out the overpriced U.S. system for 80% of care, would not be expensive if it existed. Such policies are unavailable because lobbyists have made certain that Americans are prisoners of the existing extortion racket. Why should I pay $175. for 1 month of Advair when it is sold in other countries for $30.? Why should I buy insurance that covers U.S. priced surgery when I can go elsewhere and buy the service for 1/10 the price? Why not send medicaid /medicare patients to India for care if they are fit to travel?


Cannot agree with you there. The public option is an anemic, pitiful attempt to help the self-employed (like me) obtain reasonably priced insurance. As currently conceived, it will do little to spark competition for the H.Insurance mafia.
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I can promise you, if the government gets out of the healthcare business, you will be able to afford health insurance once again.
 
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