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

[Geoff_M]

I haven't fully ready up on the whole issue, but I think there's a couple of things that I can say...

Basically, it boils down to two medical groups reaching two different conclusions about what the "optimal" detection scheme for breast cancer should be. No doubt and understandably, the ACS seems to go for the more aggressive approach at detection. But without a doubt there is some scheme where you'd reach a point of diminishing returns. Is once a year enough? Why "annual"? Is it because it's a easy to remember period of time? Would every 6 months be better? How about every two years?

The USPSTF seems to think that they're taking a more "balanced" approach by looking at other factors. Maybe they're right, and perhaps they're wrong. But I think it's a little premature to start accusing them of nefarious intentions. They aren't "the Government", as mentioned above, they a panel of doctors and health care academicians that were tasked by the US Dept. of Health and Human Services to give them opinions on certain matters. As with other such advisory panels, their recommendations aren't binding and are just that... "recommendations".

As for the charge that this is some sort of backdoor effort by the Administration at health care "rationing", well that would be a first. I can't go too far and stay within DIS guidelines, but when it comes to the concerns expressed by the current Administration in their healthcare reform efforts, there's been almost zero effort on cost control. This has been one of the chief criticisms of pending legislation... it may address questions of the number of people covered by health plans, but leaves other problems of our healthcare system to fester... chiefly among them run away costs.

 

[maroo]

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!

It doesn't surprise me at ALL that the committee members are also on the advisory boards of CMS (Centers for Medicare and Medicaid Services) and BCBS.



Makes me want to be sick.

 

[maroo]

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.

I am with you.

This is a good question. How do they propose diagnosing breast cancer in people under 50? If you are not supposed to do a self exam?

And I guess all of this educational material we have been giving patients for years about the correct way to do SBE - we are just suppose to toss away?

What happens now? This will be interesting to watch.

As a provider of medical services to cancer patients - we will be watching it closely - to see what changes these guidelines actually produce...if any?

 

[mill4023]

I haven't fully ready up on the whole issue, but I think there's a couple of things that I can say...

Basically, it boils down to two medical groups reaching two different conclusions about what the "optimal" detection scheme for breast cancer should be. No doubt and understandably, the ACS seems to go for the more aggressive approach at detection. But without a doubt there is some scheme where you'd reach a point of diminishing returns. Is once a year enough? Why "annual"? Is it because it's a easy to remember period of time? Would every 6 months be better? How about every two years?

The USPSTF seems to think that they're taking a more "balanced" approach by looking at other factors. Maybe they're right, and perhaps they're wrong. But I think it's a little premature to start accusing them of nefarious intentions. They aren't "the Government", as mentioned above, they a panel of doctors and health care academicians that were tasked by the US Dept. of Health and Human Services to give them opinions on certain matters. As with other such advisory panels, their recommendations aren't binding and are just that... "recommendations".

As for the charge that this is some sort of backdoor effort by the Administration at health care "rationing", well that would be a first. I can't go too far and stay within DIS guidelines, but when it comes to the concerns expressed by the current Administration in their healthcare reform efforts, there's been almost zero effort on cost control. This has been one of the chief criticisms of pending legislation... it may address questions of the number of people covered by health plans, but leaves other problems of our healthcare system to fester... chiefly among them run away costs.

Only thing is, it's not 2 medical groups with opposing views.
It's one group of about a dozen people on an agency sponsored by the government vs just about every other reputable group of medical experts in the country.

Regardless of intent, this recommendation will have an effect on coverage. Current government healthcare programs like Medicare make decisions about what to cover, based heavily on the recommendations of the USPSTF. If the USPSTF says they do not recommend routine mammograms for women under 50, the government is probably not going to cover routine mammograms for women under 50.

 

[DawnCt1]

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?

While no one works for nothing Carly, most people conduct their professional lives within moral parameters and sense of ethics. Most professional organizations function with ethical considerations at the forefront, as well as the advancement of science in their specialties. They have come to the conclusion that these guidelines are flawed. If you are comfortable with them, by all means, follow them. No one is going to drag you off to the dreaded xray unit. It is still your choice.

 

[maroo]

Only thing is, it's not 2 medical groups with opposing views.
It's one group of about a dozen people on an agency sponsored by the government vs just about every other reputable group of medical experts in the country.

Regardless of intent, this recommendation will have an effect on coverage. Current government healthcare programs like Medicare make decisions about what to cover, based heavily on the recommendations of the USPSTF. If the USPSTF says they do not recommend routine mammograms for women under 50, the government is probably not going to cover routine mammograms for women under 50.

They are in for a fight. In my years in the medical field, I have never seen something cause this much uproar in 2 days. Emails are flying on an organizational level. Even the DISboards is upset (usually the DIS has no idea what stupid rule was just made that will affect their healthcare). This is a discussion that is just beginning.

Medicare really doesn't cover many women between 40 and 50 years old. Unless they are disabled.

Our MediCAID patients may be affected pretty quickly, though.

The private insurance carriers usually wait for Medicare/Medicaid to make a policy change before they consider it...so maybe we have a while before this begins to affect patient care.

I hope they will call for a Hearing in Congress before they make any coverage changes, though.

 

[Geoff_M]

Only thing is, it's not 2 medical groups with opposing views.
It's one group of about a dozen people on an agency sponsored by the government vs just about every other reputable group of medical experts in the country.

I guess I don't follow the "sponsored by the Government" meme. This group has taken a different approach to the question and has come up with a different recommendation. This shouldn't come as a shock and doesn't imply that the answer was forced upon them.

Regardless of intent, this recommendation will have an effect on coverage. Current government healthcare programs like Medicare make decisions about what to cover, based heavily on the recommendations of the USPSTF. If the USPSTF says they do not recommend routine mammograms for women under 50, the government is probably not going to cover routine mammograms for women under 50.

There's a slight logical leap in that statement... at first you say "will" and then correctly imply "may". The recommendations are import input to the process, but they aren't automatically accepted. I doubt previous coverage rules will be turned on a dime based on this one recommendation, particularly given that it is a fairly significant departure from previous recommendations.

 

[DawnCt1]

Did the trial balloon pop?

Health and Human Services Secretary Kathleen Sebelius tells women: "Keep doing what you have been doing for years."
STORY HIGHLIGHTS
Advisory board has said women in 40s shouldn't get routine mammograms
Health secretary: Recommendation has caused "a great deal of confusion"
Secretary Kathleen Sebelius says findings aren't part of government policy
Sebelius: Mammograms "important life-saving tool" in breast cancer fight
Washington (CNN) -- A federal advisory board's recommendation that women in their 40s should avoid routine mammograms is not government policy and has caused "a great deal of confusion," Health and Human Services Secretary Kathleen Sebelius said Wednesday.
"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," Sebelius said in a statement.
"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."
Sebelius waded into the controversy over Monday's announcement by the U.S. Preventive Services Task Force that women in their 40s should not get routine mammograms for early detection of breast cancer.

http://www.cnn.com/2009/HEALTH/11/1...ories&utm_source=feedburner&utm_medium=feed&u

 

[DancingBear]

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.

I'm not saying they're right or wrong. I'm saying the panel and their recommendation deserves some respect and consideration. I'm saying there are a lot of baseless attacks being made here about the qualifications and motivations of the panel, and very little discussion about the scientific basis for the recommendation. I'm saying evidenced-based information about our medical care is a good thing.

BTW, this controversy did not just arise in 2009, in the midst of health care reform legislation. See the 1997 recommendations by the National Cancer Advisory Board (a similar group, albeit one that did include cancer specialists and radiologists):

http://www.nih.gov/news/pr/mar97/nci-27b.htm

 

[tink_lover]

I just noticed from your signature where you live and it gives me an idea as to why you are very much supporting the govt health initiative. Am I right?

 

[jenfur]

I am late posting on this, but really I am still in shock over this recommendation. If the basis is not money, then it is the value of lives saved vs. the number of people tested. I think its a rather crappy way to look at things. The way my insurance works now, I can get a baseline at 35, and regular mammograms starting at 40. IF I find something through BSE, the Dr. can recommend a scan then, and the insurance will pay. The fact that this panel is recommending against teaching women about self exams is what is infuriating! The MORE we learn about BSE, the better we can tell the difference between normal lumpy tissue and abnormal. We become familiar with what we feel and can detect CHANGES. HOW can they recommend against that AND against ANY other testing in women under 50? How can anyone say this is not outrageous? You know how this saves money? YOUNG WOMEN DIE! You can say that treatment becomes more expensive, but in reality, cancer is allowed to become so advanced that the treatment becomes cheap palliative care.

I wouldn't trust a thing from this panel. Did you read the recommendations on prostrate screening? It can't recommend anything in relation to testing men under 75 and recommends no testing over 75. When the heck do they intend to find prostrate cancer?

When did any testing become unnecessary after 75. For some with advanced illnesses, maybe. The population is getting older and healthier. I have seen many active and healthy 85 yr olds who could have lost 10 good years of life if they would have decided at 75 to give up on their health care rights.

 

[DancingBear]

I just noticed from your signature where you live and it gives me an idea as to why you are very much supporting the govt health initiative. Am I right?

Nope.

 

[DancingBear]

I am late posting on this, but really I am still in shock over this recommendation. If the basis is not money, then it is the value of lives saved vs. the number of people tested.

If this is true, couldn't you say the same thing about the recommendations of the American Cancer Society and others that do not recommend mammograms for women under 40? As the ACS's own statement on this issue says:

When recommendations are based on judgments about the balance of risks and benefits, reasonable experts can look at the same data and reach different conclusions.

The fact that this panel is recommending against teaching women about self exams is what is infuriating! The MORE we learn about BSE, the better we can tell the difference between normal lumpy tissue and abnormal. We become familiar with what we feel and can detect CHANGES. HOW can they recommend against that...

The issue is not whether women should become familiar with their breasts and discuss changes and such with their doctors; rather, it's about whether there is any benefit specifically from doctors teaching specific technique. There is evidence that there is not a benefit from having doctors teach technique.

Note also that the American Cancer Society says:

It is acceptable for women to choose not to do BSE or to do BSE once in a while. Women who choose not to do BSE should still be aware of the normal look and feel of their breasts and report any changes to their doctor right away.

http://www.cancer.org/docroot/cri/content/cri_2_6x_how_to_perform_a_breast_self_exam_5.asp

I wouldn't trust a thing from this panel. Did you read the recommendations on prostrate screening? It can't recommend anything in relation to testing men under 75 and recommends no testing over 75. When the heck do they intend to find prostrate cancer?

First, the issue here is whether to recommend prostate-specific antigen (PSA) screening vs. digital rectal examination. They don't recommend against PSA screening for younger men, they're just saying they don't have enough evidence of the benefits and harms to affirmatively recommend the testing. The benefits of PSA testing are hotly debated:

http://www.webmd.com/prostate-cancer/news/20090427/psa-screening-guidelines-stir-debate

 

[DancingBear]

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.

Right. So they've made a determination weighing the benefits of the testing vs. the costs, and drawn the line at 40.

 

[DancingBear]

While no one works for nothing Carly, most people conduct their professional lives within moral parameters and sense of ethics.

Except the members of the U.S. Preventive Services Task Force?

 

[DancingBear]

Did the trial balloon pop?

http://www.cnn.com/2009/HEALTH/11/1...ories&utm_source=feedburner&utm_medium=feed&u

I assume you're implying that the USPSTF's recommendation was a trial balloon by the Obama administration. Once again, that would be wrong. None of the members of the task force was selected during this administration, and they do not represent in their recommendations the federal government or any administration.

Rather, Secretary Sebelius' statement (which I linked to several posts earlier) emphasizes that the USPSTF does set the policy for the administration.

 

[OceanAnnie]

So what is one to make of the OP's original post, as well as other pps? If she and others had followed this advice she would be dead. Dead. Are they now considered disposable? Is this part of the spectrum of disposable people like the seniors having their health care altered?

 

[Piglets Mommy]

So what is one to make of the OP's original post, as well as other pps? If she and others had followed this advice she would be dead. Dead. Are they now considered disposable? Is this part of the spectrum of disposable people like the seniors having their health care altered?

That is my fear. This is one cut for one type of test for one condition. If they make similar cuts for other type tests, that's more "disposable" humans. NO HUMAN LIFE SHOULD BE DISPOSABLE!!!!

 

[DawnCt1]

I assume you're implying that the USPSTF's recommendation was a trial balloon by the Obama administration. Once again, that would be wrong. None of the members of the task force was selected during this administration, and they do not represent in their recommendations the federal government or any administration.

Rather, Secretary Sebelius' statement (which I linked to several posts earlier) emphasizes that the USPSTF does set the policy for the administration.

Medicare often accepts the recommendations of this group. Insurance companies follow the direction of Medicare.

 

[disney1990]

Personally, I think it is time to get rid of this task force -- period!