Will mammograms sink the Health Care Bill in the Senate?

 The 16-member U.S. Preventative Services Task Force released its new recommendations on mammograms a few days ago.  Talk about some outrage by its recommendations!  It said they wanted to change the standard of once a year screenings for women over 40 every other year.  Boy did the stuff  hit the fan!

Please allow me give you some quotes to aid in your evaluation of the situation;

Dr. Daniel Kopans, head of breast imaging at Massachusetts General, “I think it is outrageous to reduce costs by taking away a test that is saving lives.”  To be fair the recommendations aren’t taking away the test… just when it should start, so the Dr. may be creating a panic when it’s not warranted.   We already have counter quotes that are mis-informed and mis-leading.  Typical knee-jerk reaction.   Let’s keep going, it gets better.

Professor Theodore Marmor a health care specialist at Yale University, “Every medical care system in the world has a concern about not paying for things that shouldn’t be done.”   Yeah who wouldn’t.

A few Republicans and some groups like the American College of Radiology said this, “The guidelines were made in response to the Obama administration’s wish to save health care dollars.”  Ok maybe that is an argument but without any proof, it’s just rhetoric.   I did some research on the costs.  Here is what I found.  A standard mammography costs about $125.00.   Fairly cheap as far as any medical procedure.  However, the new digital enhanced mammograms that are far superior in detection, costs 4 times as much.   Only 8% of all mammograms are done this way.  You draw you own conclusions.

Health and Human Secretary (HHS) Kathleen Sibelius issued this statement regarding the Preventative task force recommendations. 

“There is no question that the U.S. Preventive Services Task Force Recommendations have caused a great deal of confusion and worry among women and their families across this country. I want to address that confusion head on. The U.S. Preventive Task Force is an outside independent panel of doctors and scientists who make recommendations. They do not set federal policy and they don’t determine what services are covered by the federal government.

“There has been debate in this country for years about the age at which routine screening mammograms should begin, and how often they should be given. The Task Force has presented some new evidence for consideration but our policies remain unchanged. Indeed, I would be very surprised if any private insurance company changed its mammography coverage decisions as a result of this action.

“What is clear is that there is a great need for more evidence, more research and more scientific innovation to help women prevent, detect, and fight breast cancer, the second leading cause of cancer deaths among women.

“My message to women is simple. Mammograms have always been an important life-saving tool in the fight against breast cancer and they still are today. Keep doing what you have been doing for years — talk to your doctor about your individual history, ask questions, and make the decision that is right for you.”

 Let’s examine the task force.  It was created in 1984, and is an independent wing of the HHS that Sibelius runs.  Now, the slam on them is that they were Bush appointees and they are politically motivated.  Therefore, all their research should be ignored!  Great, will we say that about Obama’s appointees in a few years?  If you are from the previous admin, you must be an idiot.  Therefore anything you say is suspect.  Get a life folks, not everyone is out to get ya!  This is what I find so distasteful in politics.  If you aren’t in the party that holds the Whitehouse, everything you say is suspect or a lie.  I am freak’in tired of that kind a garbage and I hope you don’t fall for it.   If it wasn’t for the fact that this column has some decorum, I would use some colorful metaphors to further explain myself with regards to slamming any previous administrations appointees.  Get over it!

The panel is made up by some of the smartest doctors in the country and their job is to make recommendations independent of the politics and the cost of their recommendations.  Their recommendation brought screening methods for cancer, cholesterol and diabetes to the forefront and got insurers to pay for these types of procedures when previously insurance companies refused.  These guys aren’t idiots.

Statistics from the National Cancer Institute;  ”The risk of a woman that will be diagnosed with breast cancer before she turn 50 is 2%.”  So you can see why they made the recommendation.   If you are in the 2% screening means everything to you.  But this kind of cost-benefit analysis is what runs the health care industry today.  My dental insurance pays for two teeth cleaning a year.  I go two additional times and pay for it myself.  The cost-benefit for my insurance company pencils out to two, but I know I am lazy with the flossing so I pick up the other two for that reason.  My choice.

Now, the latest is that the Health Care Plan in the Senate will be de-railed by every group that wants to keep yearly mammograms insured.  The timing of the report is bad, but not for any reasons that are political.  In 2002, the task force with different members said that screening could start at age 40, but doctors needed to explain the limitations of the test and the false positives for that age group.  That was before digital imaging.  This morning a spoke to a woman that had a false positive.  They were ready to do a painful biopsy until they ran another test and determined she had fibrous tissue.  She was in her 30′s at the time.

So, what to make of all this?   I like technology.  If digital imaging is far superior,  make it common place. 

From the patient’s perspective, a digital mammogram is the same as a standard film-based mammogram in that breast compression and radiation are necessary to create clear images of the breast.  The time needed to position the patient is the same for each method. However, conventional film mammography requires several minutes to develop the film while digital mammography provides the image on the computer monitor in less than a minute after the exposure/data acquisition. Thus, digital mammography provides a shorter exam for the woman and may possibly allow mammography facilities to conduct more mammograms in a day.  Digital mammography can also be manipulated to correct for under or over exposure after the exam is completed, eliminating the need for some women to undergo repeat mammograms before leaving the facility.

Guys have a lower pain threshold.  If we had to have our vitals squished on a regular basis, we would have invented something better a long time ago.    Don’t condemn the recommendations people seem to be.    Review with an objective reading and see if they have merit.

Get your yearly checkup if you feel the need.  Discuss any screening options with your doctors and stay educated.  And ignore what the politicians have to say on medical issues. Period!

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