If I'd Followed This Advice, I'd Be Dead.

[DancingBear]

I don't see the relevance of when or how the members of this agency were put in place.

Your post implies that this panel's recommendation is a method of carrying out a policy of the Obama administration to save health care costs. It's hard to see how that would be true of persons who were seated or selected during the prior administration.

 

[DawnCt1]

Once again, I point out that the panel's recommendation is not based on dollar costs.

Because you don't see "cost" specifically addressed, you are naive to assume that it isn't about cost. It has been pointed out to you that there are no oncologists on this panel, no radiologists, etc. What"horse" does either of those groups have in being against these recommendations. You initially alluded to a follow the money approach. Oncologists would actually do a lot better financially if diagnosis was delayed. They could administer chemo, so the money angle doesn't work for them. Breast cancer found early enough does not require their services, yet they are firmly against these recommendations. Radiologists? One of the riskiest readings for a radiologist to do are mammograms. They could do away with a lot of litigation risk if the number of mammograms readings were reduced and make a lot more money on radiation services for late diagnosed breast cancer, yet they are firmly against this. The only entity that seems to gain in these recommendations is the government as we head towards government controlled health care.

 

[Carly_Roach]

DH questions their methodology and their conclusions. He isn't in the "breast cancer or imaging business" but is extremely skilled at evaluating studies. This one is seriously flawed and based on cost savings and irrelevant risks. They used the outcome of multiple studies and merged the data and created a computer model and made predictions based upon the patients' age. They estimated that for every life saved, 45 breast biopsies had to be done. They overestimated the risk of a simple breast biopsy which resulted in negative findings. At the end of the spectrum, 75 years. That flies in the face of logic. Most breast cancer occurs after the age of 60. Maybe those 75 year olds are dying of something else but then, maybe they won't die...unless they have undiagnosed breast cancer. These same computer type models have predicted that due to global warming, the east coast should be under water by now. We aren't and its been cold.

It's probably not a good idea to back up your estimation of your husband's intelligence with a snark about global warming. My first instinct when someone snorts about global warming by pointing to the cold day (or winter) they're having is to disregard any other opinion they espouse because it's probably not based on actual facts.

I'm just sayin'.....

 

[mill4023]

How about neither? How about acknowledging the possibility that the members of this panel are trying to do their best to make a scientifically-based recommendation. Again, they set forth in great detail the evidence they've reviewed and the reasoning for the recommendation, just as they have done for many years with regard to many issues.

Most if not all of the attacks made here against this panel really address directly the points made by the panel in their recommendation. Instead, we have attacks on their qualifications and unsupported allegations that they are motivated by saving money for insurance companies (although the reason they are funded by the government is to protect from such influences) or by saving money for the government or to promote the current administration's agent (although this panel does not speak for the government, was completed seated or selected by the current administration, and the current administration has distanced itself from the recommendations).

Do you have any actual facts to back this up? Because it seems to go against everything you ever hear about the dollar costs and benefits of good preventative care.

Dr. Gary Lyman, a breast cancer oncologist at Duke University who researches comparative effectiveness, says guidelines like those issued by the USPSTF may cause a great deal of harm.

"This is a reversal of the position they took in their previous recommendations, and this flies in the face of previous guidelines from other groups in the U.S.," he said. "[While] the risk of breast cancer is less in the younger age group, 40 to 50, mammograms save lives in those age groups."

Lyman said his primary criticism is that in between the last set of screening guidelines in 2002 and the current ones, only one study has come out in the area, and it did nothing to change what doctors know about mammograms.

"I'm puzzled why, when the evidence hasn't really changed, when the estimate in benefit and risk hasn't really changed, why they reversed their position," he said.

"Tens of thousands of lives are being saved by mammography screening, and these idiots want to do away with it," said Daniel Kopans, a Harvard radiology professor. "It's crazy - unethical, really."

Oncologist Mary Daly, chair of the clinical genetics department at Fox Chase Cancer Center in Philadelphia, said the reevaluation was flawed by its reliance on data from outmoded technology, namely film mammography. Digital mammograms, the new standard, have reduced the false-positive rate in women under 50.

"I'm not pleased, because I don't want any more women to die of breast cancer than have to," she said. "I'm going to tell my patients to continue getting screened as they have been. I'm willing to sit down and go over the data if they want to."

The new recommendations took on added significance because under health-care legislation pending in Congress, the conclusions of the 16-member task force would set standards for what preventive health-care services insurance plans would be required to cover.

Health care reform legislation being considered in the House and Senate seeks to ensure coverage of preventive services as part of a basic benefits package in all health insurance plans, as well as patient cost-sharing protections for these services. In determining which services should be covered, the bills rely heavily on the USPSTF recommendations. At a minimum, covered preventive services would be those that receive an A or B grade from the USPSTF.

"The American Cancer Society continues to recommend annual screening using mammography and clinical breast examination for all women beginning at age 40. Our experts make this recommendation having reviewed virtually all the same data reviewed by the USPSTF, but also additional data that the USPSTF did not consider."

The congressional mandate establishing the USPSTF charges it with reviewing "the scientific evidence related to the effectiveness, appropriateness, and cost-effectiveness of clinical preventive services for the purpose of developing recommendations for the health care community."

You can believe what you want.
I think I'll stick with the medical experts rather than the cost-effectiveness experts.

 

[DancingBear]

You can believe what you want.
I think I'll stick with the medical experts rather than the cost-effectiveness experts.

So now the members of this panel are not only lie about their reasoning but are not medical experts? Just so you know, here is the list of folks you are defaming:

Members of the USPSTF

The USPSTF comprises primary care clinicians (e.g., internists, pediatricians, family physicians, gynecologists/obstetricians, and nurses). Individual members' interests include: decision modeling and evaluation; effectiveness in clinical preventive medicine; clinical epidemiology; the prevention of high-risk behaviors in adolescents; geriatrics; and the prevention of disability in the elderly.

Current members of the Task Force are listed below. They have recognized expertise in prevention, evidence-based medicine, and primary care.

Bruce N. Calonge, M.D., M.P.H. (Chair)
Chief Medical Officer and State Epidemiologist
Colorado Department of Public Health and Environment, Denver, CO

Diana B. Petitti, M.D., M.P.H. (Vice Chair)
Professor of Biomedical Informatics
Fulton School of Engineering
Arizona State University, Tempe, AZ

Susan Curry, Ph.D.
Dean, College of Public Health
Distinguished Professor
University of Iowa, Iowa City, IA

Allen J. Dietrich, M.D.
Professor, Community and Family Medicine
Dartmouth Medical School, Hanover, NH

Thomas G. DeWitt, M.D.
Carl Weihl Professor of Pediatrics
Director of the Division of General and Community Pediatrics
Department of Pediatrics, Children's Hospital Medical Center, Cincinnati, OH

Kimberly D. Gregory, M.D., M.P.H.
Director, Maternal-Fetal Medicine and Women's Health Services Research
Cedars-Sinai Medical Center, Los Angeles, CA

David Grossman, M.D., M.P.H.
Medical Director, Preventive Care and Senior Investigator, Center for Health Studies, Group Health Cooperative
Professor of Health Services and Adjunct Professor of Pediatrics
University of Washington, Seattle, WA

George Isham, M.D., M.S.
Medical Director and Chief Health Officer
HealthPartners, Minneapolis, MN

Michael L. LeFevre, M.D., M.S.P.H.
Professor, Department of Family and Community Medicine
University of Missouri School of Medicine, Columbia, MO

Rosanne Leipzig, M.D., Ph.D
Professor, Geriatrics and Adult Development, Medicine, Health Policy
Mount Sinai School of Medicine, New York, NY

Lucy N. Marion, Ph.D., R.N.
Dean and Professor, School of Nursing
Medical College of Georgia, Augusta, GA

Joy Melnikow, M.D., M.P.H.
Professor, Department of Family and Community Medicine
Associate Director, Center for Healthcare Policy and Research
University of California Davis, Sacramento, CA

Bernadette Melnyk, Ph.D., R.N., C.P.N.P./N.P.P.
Dean and Distinguished Foundation Professor in Nursing
College of Nursing & Healthcare Innovation
Arizona State University, Phoenix, AZ

Wanda Nicholson, M.D., M.P.H., M.B.A.
Associate Professor
Johns Hopkins School of Medicine and Bloomberg School of Public Health, Baltimore, MD

J. Sanford (Sandy) Schwartz, M.D.
Leon Hess Professor of Medicine, Health Management, and Economics
University of Pennsylvania School of Medicine and Wharton School, Philadelphia, PA

Timothy Wilt, M.D., M.P.H.
Professor, Department of Medicine, Minneapolis VA Medical Center
University of Minnesota, Minneapolis, MN

http://www.ahrq.gov/clinic/uspstfab.htm

 

[DancingBear]

Because you don't see "cost" specifically addressed, you are naive to assume that it isn't about cost. It has been pointed out to you that there are no oncologists on this panel, no radiologists, etc. What"horse" does either of those groups have in being against these recommendations. You initially alluded to a follow the money approach. Oncologists would actually do a lot better financially if diagnosis was delayed. They could administer chemo, so the money angle doesn't work for them. Breast cancer found early enough does not require their services, yet they are firmly against these recommendations. Radiologists? One of the riskiest readings for a radiologist to do are mammograms. They could do away with a lot of litigation risk if the number of mammograms readings were reduced and make a lot more money on radiation services for late diagnosed breast cancer, yet they are firmly against this. The only entity that seems to gain in these recommendations is the government as we head towards government controlled health care.

I'm sorry, my head is spinning. I thought the conspiracy was that the government wants to cut health care costs, and yet you're saying this policy would lead to oncologists and radiologists making more money.

 

[mill4023]

So now the members of this panel are not only lie about their reasoning but are not medical experts?

No, they've actually been pretty honest about their reasoning. They said mammograms are just as effective at preventing cancer deaths in women 40 to 50 as they are in women over 50, but because they cause too many false positives and unneeded biopsies in women under 50, they shouldn't be done.

In other words, it's better to have a small number of women die of breast cancer than to have a large number of women have unnecessary biopsies. Probably cheaper too.

Groups like the American Cancer Society, the Mayo Clinic, American College of Obstetrics and Gynecology, American College of Radiology are all medical experts. They all strongly disagree with the USPSTF.

The USPSTF may be "medical experts", but they are also a government agency and one of their goals is efficiency and cost-effectiveness.

 

[DawnCt1]

So now the members of this panel are not only lie about their reasoning but are not medical experts? Just so you know, here is the list of folks you are defaming:

http://www.ahrq.gov/clinic/uspstfab.htm

Thank you for posting that. You made my point. I see the following, and not one oncologist, general surgeon, breast health surgeon, oncological surgeon, radiologist, but there is an economist.

Chief Medical Officer and State Epidemiologist

Professor of Biomedical Informatics
Susan Curry, Ph.D.
Dean, College of Public Health

Allen J. Dietrich, M.D.
Professor, Community and Family Medicine

Thomas G. DeWitt, M.D.
Carl Weihl Professor of Pediatrics

Kimberly D. Gregory, M.D., M.P.H.
Director, Maternal-Fetal Medicine and Women's Health Services Research


David Grossman, M.D., M.P.H.
Medical Director, Preventive Care and Senior Investigator, Center for Health

George Isham, M.D., M.S.
Medical Director and Chief Health Officer


Michael L. LeFevre, M.D., M.S.P.H.
Professor, Department of Family and Community Medicine


Rosanne Leipzig, M.D., Ph.D
Professor, Geriatrics and Adult Development, Medicine, Health Policy


Lucy N. Marion, Ph.D., R.N.
Dean and Professor, School of Nursing


Joy Melnikow, M.D., M.P.H.
Professor, Department of Family and Community Medicine

Bernadette Melnyk, Ph.D., R.N., C.P.N.P./N.P.P.
Dean and Distinguished Foundation Professor in Nursing

Wanda Nicholson, M.D., M.P.H., M.B.A.
Associate Professor
Johns Hopkins School of Medicine and Bloomberg School of Public Health, Baltimore, MD

J. Sanford (Sandy) Schwartz, M.D.
Leon Hess Professor of Medicine, Health Management, and Economics


Timothy Wilt, M.D., M.P.H.
Professor, Department of Medicine, Minneapolis VA Medical Center
University of Minnesota, Minneapolis, MN

 

[Carly_Roach]

Thank you for posting that. You made my point. I see the following, and not one oncologist, general surgeon, breast health surgeon, oncological surgeon, radiologist, but there is an economist.

That's funny; what I see when I look at that list is educated people.

Chief Medical Officer and State Epidemiologist

Professor of Biomedical Informatics

Dean, College of Public Health
Distinguished Professor

Professor, Community and Family Medicine

Professor of Pediatrics

Director of the Division of General and Community Pediatrics

Director, Maternal-Fetal Medicine and Women's Health Services Research

Medical Director, Preventive Care and Senior Investigator, Center for Health Studies, Group Health Cooperative

Professor of Health Services and Adjunct Professor of Pediatrics

Medical Director and Chief Health Officer

Professor, Department of Family and Community Medicine

Professor, Geriatrics and Adult Development, Medicine, Health Policy

Dean and Professor, School of Nursing

Professor, Department of Family and Community Medicine

Associate Director, Center for Healthcare Policy and Research

Dean and Distinguished Foundation Professor in Nursing
College of Nursing & Healthcare Innovation

Associate Professor Johns Hopkins School of Medicine and Bloomberg School of Public Health

Professor of Medicine, Health Management, and Economics

Professor, Department of Medicine, Minneapolis VA Medical Center

You may disagree with them, but obviously there are many others who believe they know what they're talking about.

 

[maroo]

Since I am sitting in an oncologists office - I can assure you that we treat many patients under the age of 50 whose cancers were detected using either self breast exam or mammography.

The treatment outcomes for early detection are well documented.

How many people have died this year from "stress" of having a false positive reading? How many people have died from a complication of a breast biopsy? I would really like to know those figures.

How many people in the US were diagnosed with breast cancer under the age of 40? How many of those were saved by standard treatment? How many of those had no prior family history or other indication that they should have an earlier mammogram?


As the daughter of a breast cancer survivor - who was diagnosed in her 40's - I can assure you that this recommendation was even more concerning as a daughter. She had no previous "family history" of breast cancer or any symptoms. She went in for her yearly mammogram - and it saved her life.

So they can save their recommendations.

The sad thing...for those that don't have a "reason" to get one early - your insurance company may not pay - citing these "recommendations."

 

[DancingBear]

The USPSTF may be "medical experts", but they are also a government agency and one of their goals is efficiency and cost-effectiveness.

No, they are not a government agency, and their mission is as follows:

The U.S. Preventive Services Task Force (USPSTF), first convened by the U.S. Public Health Service in 1984, and since 1998 sponsored by the Agency for Healthcare Research and Quality (AHRQ), is the leading independent panel of private-sector experts in prevention and primary care. The USPSTF conducts rigorous, impartial assessments of the scientific evidence for the effectiveness of a broad range of clinical preventive services, including screening, counseling, and preventive medications. Its recommendations are considered the "gold standard" for clinical preventive services.

The mission of the USPSTF is to evaluate the benefits of individual services based on age, gender, and risk factors for disease; make recommendations about which preventive services should be incorporated routinely into primary medical care and for which populations; and identify a research agenda for clinical preventive care.

Background and Mission

Public Law Section 915 mandates that AHRQ convene the USPSTF to conduct scientific evidence reviews of a broad array of clinical preventive services, develop recommendations for the health care community, and provide ongoing administrative, research, technical, and dissemination support.

 

[DancingBear]

...but there is an economist.

That's an economist who is also a board-certified internist:

Dr. Schwartz, a board-certified internal medicine specialist, is the Leon Hess Professor of Medicine, Health Management, and Economics at the University of Pennsylvania School of Medicine and Wharton School. He is past president of the American Federation of Clinical Research and the Society for Medical Decision Making, former Executive Director of the Leonard Davis Institute of Health Economics, and past Editor of the American Journal of Managed Care. An expert in the evaluation of medical practices and guidelines, Dr. Schwartz has served on the National Institutes of Health and Institute of Medicine committees in these areas. He is a member of the Centers for Medicare and Medicaid Services Medical Care Advisory Committee and the Blue Cross and Blue Shield Associations Medical Advisory Panel.

 

[DancingBear]

No, they've actually been pretty honest about their reasoning. They said mammograms are just as effective at preventing cancer deaths in women 40 to 50 as they are in women over 50, but because they cause too many false positives and unneeded biopsies in women under 50, they shouldn't be done.

In other words, it's better to have a small number of women die of breast cancer than to have a large number of women have unnecessary biopsies.

I guess by this reasoning the American Cancer Society, et. al. think it's better to have a small number of women under 40 die of breast cancer than to have a large number of women have unnecessary biopsies.

 

[mill4023]

No, they are not a government agency, and their mission is as follows:

Sorry, I've lost track of exactly what point you are trying to make.

Are you saying that this group (government agency or sponsored by government agency, whatever) is right and virtually every other group of medical experts in the country is wrong?

If that is the case, then I'd really like to know what reasoning you use to determine that.

If that is not the case, all the discussion of the reasoning behind the groups recommendation is really irrelevant. The bottom line is that according to virtually all medical experts, this group is making a very bad recommendation that will cause more breast cancer deaths if followed and will lead to less insurance coverage for a procedure that is a lifesaver for thousands of women in this country every year.

If you'd like to continue defending that viewpoint, have fun. I think you're going to be very lonely over there.

 

[DawnCt1]

That's funny; what I see when I look at that list is educated people.


You may disagree with them, but obviously there are many others who believe they know what they're talking about.

They may be educated but it is clear from the list that their expertise doesn't lie in breast cancer. Who are the "many others"? The professional organizations who care for women with breast cancer on a daily basis? I don't think so. This is about $$$. Nothing more, nothing less. To pretend it isn't is naive.

 

[DawnCt1]

No, they are not a government agency, and their mission is as follows:

Dr. Schwartz, a board-certified internal medicine specialist, is the Leon Hess Professor of Medicine, Health Management, and Economics at the University of Pennsylvania School of Medicine and Wharton School. He is past president of the American Federation of Clinical Research and the Society for Medical Decision Making, former Executive Director of the Leonard Davis Institute of Health Economics, and past Editor of the American Journal of Managed Care. An expert in the evaluation of medical practices and guidelines, Dr. Schwartz has served on the National Institutes of Health and Institute of Medicine committees in these areas. He is a member of the Centers for Medicare and Medicaid Services Medical Care Advisory Committee and the Blue Cross and Blue Shield Associations Medical Advisory Panel.

I realize he is a physician. He is an internist. Unless he is an internist with a subspecialty in oncology, he has no day to day expertise in the care of women with breast cancer. Also note that he is a member for Medicare and Medicaid; government agencies who NEED to save money. Again, you made my point. Fortunately health insurance companies are going to ignore these guidelines and support mammograms for women over 40.

 

[Carly_Roach]

They may be educated but it is clear from the list that their expertise doesn't lie in breast cancer. Who are the "many others"? The professional organizations who care for women with breast cancer on a daily basis? I don't think so. This is about $$$. Nothing more, nothing less. To pretend it isn't is naive.

I hate to be the one that breaks this to you Dawn, but EVERYTHING is about money.

Even the American Cancer Society.

Even your doctor.

Are you just now tumbling to this fact or do you reserve it for anything you happen to disagree with?

 

[mill4023]

I guess by this reasoning the American Cancer Society, et. al. think it's better to have a small number of women under 40 die of breast cancer than to have a large number of women have unnecessary biopsies.

They don't recommend it because the real experts in mammography(radiologists and oncologists) have determined that it's not an effective diagnostic tool because of the denser breast tissue in women under 40.

 

[DawnCt1]

Since I am sitting in an oncologists office - I can assure you that we treat many patients under the age of 50 whose cancers were detected using either self breast exam or mammography.

The treatment outcomes for early detection are well documented.

How many people have died this year from "stress" of having a false positive reading? How many people have died from a complication of a breast biopsy? I would really like to know those figures.

How many people in the US were diagnosed with breast cancer under the age of 40? How many of those were saved by standard treatment? How many of those had no prior family history or other indication that they should have an earlier mammogram?


As the daughter of a breast cancer survivor - who was diagnosed in her 40's - I can assure you that this recommendation was even more concerning as a daughter. She had no previous "family history" of breast cancer or any symptoms. She went in for her yearly mammogram - and it saved her life.

So they can save their recommendations.

The sad thing...for those that don't have a "reason" to get one early - your insurance company may not pay - citing these "recommendations."

Excellent points! I would be willing to suffer the "agony" of waiting for a the results of a negative biopsy, rather than suffer from breast cancer any day!

 

[PlainJane]

I'm the daughter of a woman who was diagnosed in her late 30s. This was back in the early 90s, and she was the one who originally found the lump in a self exam. She had to fight for months with doctors to even get a mammogram. Even after the test came back with concerning results and possible cancer, she had to continue to fight for further testing to get a final diagnosis.

She had no family history.

So, if we no longer to self checks or mammograms for those under 50, how do you diagnose?

I'm beyond disgusted by this decision, and the reasons behind it.