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.