Breast Intentions

So, I try to tread carefully these days on healthcare topics, given that I write on medical and healthcare topics. But as my work in this area is currently limited to pharmaceutical research and pharma business dealings, I think that saying a bit about the recent changes in recommendations to breast cancer screening are pretty safe. Because, I’m not writing about insurance payers and health coverage.

In short, I think the recommendations are questionable at best. In case you’ve missed the news, here’s a rundown:

The United States Preventive Services Task Force (USPSTF) made recommendations on Nov. 16, 2009 that routine screening mammograms start at age 50 (rather than age 40, which had been the standard) and be done less frequently (every 2 years, not annually as before). Also, the task force advised that physicians no longer teach women how to do breast self-examinations.

I realize that these recommendations are, in large part, based on scientific research. For example, it seems that later mammograms may not really increase rates of mortality or morbidity, and there is concern that when women have suspicious (but ultimately benign) findings, they undergo undue stress as a result.

None of this changes my opinion that the recommendations are totally wrongheaded.

The fact is that even with the chance of finding suspicious things that turn out to be harmless, we should aggressively go for prevention and early detection, particularly with diseases that are high on the list of killers. Breast cancer is a major killer of women. And even though breast self-exams may not be the most reliable thing in the world, it boggles my mind that someone would advise against teaching women to be more aware of their body and to check it.

Furthermore, the recommendations don’t really take into account things like higher rates of breast cancer in certain groups (like black women) and earlier onset of the disease in those same groups.

But, you may say, these are simply guidelines.

I would say, don’t be naive.

You see, guidelines have a nasty habit of becoming policy with regard to insurance companies. And if insurance companies use these guidelines to change their policies and save money (and they likely will…or most of them, anyway), that means physicians will not be doing the exams for many women, unless those women can pay out of their own pocket. They couldn’t afford to absorb the cost to their offices.

And let’s face it. If you support these guidelines as a way to reduce waste and spending, without considering the lives saved in the process, I would ask you: How would you feel if your wife, or sister, or mother, were to die of breast cancer because it wasn’t caught early.

Because some guidelines said it wasn’t worth it.

9 Responses to “Breast Intentions”

  1. 1 Inda Pink
    November 26, 2009 at 1:48 pm

    I hate hate HATE HATE these recommendations and I’m hard pressed not to hate everyone who had a hand in them. Maybe they meant well but this is stupid idiotic moronic lackwitted and dumb.

  2. 2 Deacon Blue
    November 26, 2009 at 2:01 pm

    Something I should also point out, which I didn’t make clear in my post, is that while science-based research is much of what led to this current set of recommendations, that doesn’t mean I think it’s something we should put so much stock in.

    Research has a habit of telling us one thing…or seeming to…and then we find out something else. Hence it wasn’t so long ago that women were told that hormone replacement therapy was good for them…and then they were told it was bad for them…and then we found out the truth was most likely in the middle.

    While there may be questions about whether earlier screening of breast cancer will do much to change things for the better, I would say, again, that MORE screening for diseases that are major killers, right near the top of the list, is ALWAYS a good thing. Our goal should be to save lives, and not save money.

    Some may claim that these guidelines are a sign of Obama beginning to ration healthcare in preparation for socialized medical care and the end of life as we know it (*YAWN*), but those would be the same people who, if Bush were in charge, would have said this was a wise decision to keep health insurance companies from being forced to pay on all sorts of unnecessary screening.

    Fact is that this team was probably working on this before Obama took office.

    And while it may not be about rationing healthcare, and it may not be about bending over for the insurance industry, the fact remains that this is all more about saving money than it is about saving lives. That can be a good thing when a disease isn’t common. Breast cancer is VERY much a common and frequent killer of women, and should be pursued aggressively.

    And if you think cancer and physician groups have some deeply vested financial interest in keeping mammograms at the traditional levels, wake up. The cancer associations have nothing to gain from it other than continuing to try to save lives. And doctors aren’t going to live or die financially with this kind of change.

    But it could mean all the difference in the world for woman who might develop breast cancer.

    And those who love them.

  3. 3 Inda Pink
    November 26, 2009 at 4:54 pm

    Notice the symmetry today Deke? Breast talk on turkey day?


  4. 4 Deacon Blue
    November 26, 2009 at 5:00 pm

    Nah. You know I’m all about the thighs and legs. Dark meat for me all the way. So, no, there is no thematic connection.

    What are you doing at the computer anyway? I have an excuse, since our friends aren’t starting their festivities until 5-ish. You being antisocial with Sir Pink and the extended family? Or the football games too boring for you?

  5. 5 Inda Pink
    November 26, 2009 at 5:54 pm

    Giving myself just enough space to avoid spatting with in-laws.

    or blood relations for that matter.

  6. November 27, 2009 at 8:37 am

    Sadly, the change in guidelines is about money. I stand by my opinion that health care reform will not be health care reform until congress is required to use public health care. I’ve had a nurse ask me about resuscitation procedures for my Aunt (how far should we go to save her…life support policy, ect.) In FRONT of my Aunt. It was a thinly veiled, medically jargoned version of “Hey, if this bitch starts struggling, we should let her die, right? and would you sign right here?”
    I was flabbergasted.

  7. 7 Deacon Blue
    November 27, 2009 at 5:12 pm

    Congress does usee public health care…LOL…publicly funded, anyway. 😉 But with the level of care that people can usually only get with gobs of personal cash or by paying out huge premiums for good insurance policies.

    So nice to get all the good stuff without having to pay for it to keep legislators from having a real perspective on things.

    I know that cost containment at a certain level is necessary. And the fact is that most physicians, nurses, etc. want to give good care and are often stymied by administrative policies and tight budgets. So lest anyone like Thordaddy come in here to accuse me of more “radical” ideas, I know that choices have to be made.

    I just think this choice is wrongheaded.

    So, Chris, I fundamentally agree with you that healthcare reform needs to be much deeper and broader than what we’ll probably get. But I also do think that sometimes, hard choices have to be made because there are only so many resources to go around.

    It’s a tough situation.

  8. November 28, 2009 at 7:29 pm

    i’ve been getting routine mammagraphies since i’m 28. yes, i said 28. except for hte many years i was pregnant or breastfeeding [maybe 8 years in all?] every autumn, i’d get my boobs squished. i have dense breasts, an odd cyst, a strange but absolutely benign growth,a nd nothing else. the new multiphasic mammograms are heaven, more comfortable than an MRI [yeah i’ve had that too] i’m considered high risk for multiple reasons.
    and i endorse the traditional ‘get the girls squeezed’
    i am so happy i’ve had nothing serious, just minor things they keep in my file AND WATCH FOR CHANGE.
    i’ve known too many women who died of breast cancer. one was 47. one was 32. both cancers found during routine screenings. i also know countless women who are 5 or 10 year survivors because of routine screenings.

    don’t even get me started on PAP smears, i WILL get ugly.

    but guys get their PSA and VIAGRA covered. who writes this stuff?

    btw, did you see the latest: a new drug to enhance female libido is pending approval. the last drug that was considered effective for women was squashed because ‘it only dealt with teh physical aspects, not the metal and emotional aspects of sexual arousal’
    EXCUSE ME? de we hear doctors grilling men on the mental and emotional component when they’re dispersing little blue pills? EXCUSE ME? in this century we still have a problem with women GETTING HORNY AND ACHEIVING ORGASM? EXCUSE ME?

    we now return to our regularly scheduled edting work already in progress…

  9. 9 Deacon Blue
    November 28, 2009 at 7:42 pm

    You won’t get one iota of argument from me that healthcare and pharmaceuticals are still far too skewed toward men (and Caucasian men most particularly, but the racial/ethnic aspect is sometimes hard to overcome in research and clinical trials, though, sometimes through no fault of the companies…other times through ignorance of course).

    Mrs. Blue and I both lost our mothers to cancer. Not breast cancer, but all the same, it makes me rather sensitive to these issues, as my mom did die of a woman’s cancer (ovarian cancer)…also, a good friend of mine from college is a breast cancer survivor.

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Deacon Blue is the blogging persona of editor and writer Jeffrey Bouley. The opinions of Jeff himself on this blog, and those expressed as Deacon Blue, in NO WAY should be construed as the opinions of anyone with whom he has worked, currently works, or will work with in the future. They are personal opinions and views, and are sometimes, frankly, expressed in more outrageous terms than I truly feel most days.

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November 2009

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