When I saw that United States Preventive Service Task Force (USPSTF) had decreed women no longer should have a mammogram at age 40 and after 50 only have one every other year, skipping breast self exams completely, and doctors should stop examining women's breasts during their physicals, I shook my head. The constant stream of contradictory medical information seems to be part of our culture. Today what is good will be what is bad tomorrow.
This particular Health and Human Services Commission is made up of: Task Force members. They apparently were only using other studies to come up with a conclusion, but their conclusions seemed a little odd. They decided what studies mattered most but had no oncologists, just professors, general doctors, or health care managers? What is their motive?
Although they said some lives are saved by early mammograms and manual examination, they decreed it's not enough to warrant the cost. Excuse me... to which families?
The concern does not appear to be the radiation from the machines because those have been improved a lot since I began having mammograms sometimes in my late 40s or early 50s. Back then it was a lot more iffy when a woman should have her first one.
Until this study it had been agreed that women should have a baseline mammogram at around 40, but I had not understood it needed to be done yearly. The commission's argument for changing this, besides not enough lives will be saved, was it upsets women to have them... Excuse me again. *taking some deep breaths*
So they want to spare women the upset because... because... wait for it. It costs money to do biopsies. You knew it would get down to this because if it's not about saving lives, not about the radiation, then what drawback could there be other than money?
I read some arguments that for women to fight against this means they don't want health care reform, that they are ignoring medical science. Get it straight. This was a recommendation based on many studies, but they must never have read the ones that claim mammograms do save lives. Well they knew they do but just not enough to be cost effective.............................. To add to it, they make their excuse based on it's scaring women. Women get scared of lots of things. Going to spare us them all?
This 'recommendation' does not appear to be aimed at possible new health care reform, which might not even happen; but instead that insurance companies would no longer have to cover yearly mammograms before the age of 70. And why we don't want our doctor examining our breasts in a physical? Well it's uncomfortable for sure but otherwise, why? Because he might find something? *more deep breaths*
Coincidentally, I had a physical this week. My doctor brought up the mammogram task force's recommendation and said to ignore it. He ignored it when he did a thorough breast exam. I had already decided that I wouldn't consider it in my own choice, but what if insurance companies stop paying for them?
We are bombarded by studies and results. To me having a yearly mammogram doesn't seem to be that costly. They said it doesn't catch the really fast growing cancers. Fine, that's why monthly breast exams and having your doctor do one. If we are going to save money on medical costs, it seems to me we could start with something else... how about prostate tests and exams? *s*
Where I haven't been regular with having yearly physicals (my doctor teasingly said he hadn't seen me in 3 1/2 years), with a grandmother, aunt, and younger cousin who have had breast cancer, I have been faithful to those yearly mammograms. I know they don't catch everything, but what they do catch is earlier than we could feel it. And yes, they are not fun; so that's a reason to not do them?
No illustrative photos for obvious reasons.........
22 comments:
It is just crazy...! It's like the Emperors "new clothes"....Women know better than anyone what is important for them to do in terms of their Self-Breast Examination, etc., etc...This Task Force juat makes my blood boil! Everything about their "findings" is as bogus as a Three Dollor Bill!
And now we have the recomendations about Cervical Cancer exams, as well.
M-O-N-E-Y. That's what it is all about.
Just like the WARS are all about
O-I-L!
Do they think all women are stupid??????? I guess the do.
Rain . . . This so called task force must have been hired by morons. What do you want to bet that it was funded with our tax dollars. My wife's first words: "They've got to be kidding".
Dixon
I agree with the last husbands wife.
They have gotto be kidding!
I love it when I agree with you Rain, and on this it's 100% agreement!
I also understand that the new health care reforms will look to these groups for quidlines on our new health care policy. Great! Makes me feel real confidnet.
You know I can remember when some women had to pay for their own mamograms. It hasn't been that long ago. Dispicable !
Have a nice weekend Rain!
I have a novel idea. Why not make it a decision between the patient and the doctor whether a mammogram is needed. I heard on the radio the other day about a guy that found a lump and got a mammogram and sure enough it was cancer. He probably did not fall into the guidelines either.
Here is an appropriate photo of two boobs for you.
http://blogs.smh.com.au/whitehouse08/obama_biden.JPG
Well it would be, ingineer, or your medical clinic, even now but it's who will pay for it that is at debate here. Insurance decides (unless you have a cadillac policy that I bet you don't pay the full premium to have), Even if your doctor could order any test with no medical reason, just to get more tests, which is happening some places and it's what has put the medical costs so high, he might opt not to if he had guidelines he thought were meaningful. This panel was not about forcing insurance companies to change their ways. It was about telling them it would be wiser and giving them an excuse.
A small example of how insurance works (in case you do have one of those policies where everything is paid period with no questions), would be my daughter's experience with flu shots last year. She is allergic to thimerisol. The doctor said the way for her to not have a bad reaction to her shot is have it in two doses, like two children's doses. Insurance will only pay for one. Do not kid yourself that most insurance limits what can and cannot be done unless the patient can afford to pay for the extra. Women could do that with yearly mammograms even if insurance guidelines change.
And yes, men can get breast cancer, as they can osteoporosis. Routinely they are not screened for bone density as are women but they should be. And in any physical, your doctor should examine your breasts if you are a man. You should do self exams whether they tell you to do it or not as it happens-- just rarely.
On your photo, I'll skip looking at it but would you have said that was treasonous to do that to Bush/Cheney when we are a country at war? You weren't by chance one of those who destroyed Dixie Chicks records and boycotted them after they just said they didn't respect GW Bush...
Another example of how insurance works was awhile back I was told i needed surgery. I wanted a second opinion. I could get it within the clinic where my doctor works but IF I wanted it from outside, to be sure it was the right choice, I had to pay for it. I did do that. Insurance has a lot of power for what will and will not be done by your own doctor also. He knows what they will or will not cover. Mine suggested ways for me to get a better price on a shingles inoculation, which i need to do, and it was shop around where they have deals at pharmacies. He also told me one advantage of Medicare is that I could go to any specialist without a referral from him which would be brand new for me after many years with an HMO. But since I am satsified with the HMO way after all those years, I am choosing a supplemental to the Medicare which might again limit my choices of specialists (trying to figure out what it covers isn't easy).
The only solution to the complexity of our insurance system is single payer (with and maybe a few less covered choices for a few people) with everybody getting medical care when they need it which is definitely not happening right now. It's a shame we have to have insurance at all-- especially as a money-maker for the stock market and those companies. How about non-profit and everybody gets help? Unfair to who?
I'll admit that I did not read the report; but, from the news reports that I heard on NPR, it did not say that women should not get mammograms and exams. It said that they should not be administered routinely - which is much different. If one is at high risk or if one is paranoid about breast cancer, they should continue to get screenings, as before.
I disagree with all of the furor over any suggestion of limiting what procedures should be done. It is the mind set of "do everything possible" that has jacked up the cost of our health care to such idiotic proportions of our national expenditures. Perhaps it is better to spend more money on something vital (like health care) rather than new draperies or more coffee mugs; but, I do believe in doing a cost/benefit analysis.
BTW: Prostate cancer screenings have been like breast cancer screenings: there are/have been those who advocate not doing the screenings routinely.
P.S. Pardon my omission of name, and let me add that by limiting less effective health care procedures, the money may be applied toward vital things like global birth control and basic food and health care for all.
Cop Car
I don't have a problem with guidelines set up for what tests are reasonable and have purpose. To assume all doctors would be reasonable about what they might order, or to assume all patients would be responsible for what they'd request, ignores human nature. What I had a problem here was the reasons they gave for not wanting to see early mammograms and self exams and it clearly was only about saving money-- not good medical practices
The issue though, cop car, is are they unnecessary? Why did they include breast exams and your doctor checking your breasts? The reason they gave was he might find something and it would have to be explored and would not find cancer but when it did, it wasn't often enough to justify its cost.
For years studies have told us that having a yearly mammogram catches things early. Now they have decided it scares women, leads to unnecessary tests and only saves a certain number of women per thousand instead of a great number of women per thousand as was the case when it's done later.
What I had heard as a recommend and told my daughter is have a mammogram around 40 (her doctor requested her to do the same thing) which she has yet to do at 43 but I wouldn't say every year after that and nobody would make anybody have it yearly.
If this study had actually shown it had a purpose other than saving money, then I'd listen to it but it flies in the face of every other study and uses the excuse only x number of women will die without it, which isn't worth the cost (except to those women and their families).
The new mammograms use less radiation and detect far better. The only two times I have had suspect mammograms, I had an ultrasound, not a biopsy to show that it was cysts in a combination that fooled the mammogram machine. That doesn't seem to happen with today's machines or I haven't had it happen in a long while.
Certainly some families would opt to pay for it anyway but some don't have that extra money and will take the task force to know what they were talking about but if you looked at who was on it, it makes you wonder how their expertise helped them make a decision on anything other than managing the cost of health care, not giving good health care.
oh and on the prostate, I am a huge believer in the blood work. My brother's life would have been considerably shorter had he not had that test. When they found his cancer, it wasn't yet detectable other ways and was of the very virulent type which would have meant no hope if it had been caught other than through the blood test. Incidentally it was a VA hospital that saved his life.
I appreciate those of you who have dissented on this though as it's important to discuss such issues and if we all agree, we don't do that. This is actually a very important one to most families because breast cancer is as frightening to women as any other kind even when it's not the one that kills the most women. it's because it strikes at the heart of our femininity. Having watched an aunt die from breast cancer because it wasn't caught early, it's a very cruel disease to boot.
yes, I had a feeling it was all about money....it'll save insurance companies money if we don't test annually. bastards.
I did some looking and found without insurance a mammogram costs around $100, more in some states. So they are affordable for most families if insurance stops covering them. The real question would be, if a woman opted to pay for one where they found something a doctor considered suspicious, would insurance cover that since it's the real item they are trying to save money on.
As a two time breast cancer survivor I can only say bah humbug. I did catch my first tumor myself but a mammo caught the second. Admittedly, I was in my early 50s the first time and 59 the second time.
Come on Rain just trying a little humor here. I thought the photo was funny and would have thought it was funny of W. and Cheney too. Comedy is not usually treasonous. As for the Dixie Chicks I thought is was stupid of her to say, but I still listened to their music. Like most Hollywood and Music people I think they should stick to what they know and keep the political commentary off the public airwaves. Most of them are dumber than a box of rocks. There are exceptions to that rule, but not many.
As for the recomendation, I do not think it is so much what they said that has people on the right worried. It is the fact that the Dems are trying to have a government takeover of the healthcare system and when the government Advisory panels get full control over just what gets performed and paid for, then what is going to be the recourse of the patient. Their will be no lawsuits or protesting to the government regulators because they will be the ones making the decisions in the first place.
I'm not real crazy about the health care system as it is with insurance companies calling the shots based on profits.
You know the Republicans said the same things about medicare and Social Security. Where would most old people be today without those two things? Where you cannot 'sue' the government, you can vote them out of office. How do we vote out of office the CEO of say Humana?
As for the jokes, I just think it's ironic that many who did find fault with them for saying what they believed, which turned out to be what a lot of people ended up thinking, got them death threats and now we have Obama put up to ridicule and that's okay. It's still in a time of war...
Data: My mother (in her 60s), one of her sisters (in her 60s), and I (in my 50s) had "suspicious" areas found by mammography (and others in my aunts and cousins may have been found that I don't know about). Ultrasound added no information in any of the three cases, and each "required" surgical biopsy. None was cancerous.
OTOH, my sister-in-law found her own cancer and died of it within two years. The mammograms that she had undergone since age 40 had found nothing. She died at age 50.
These data are far from conclusive; but, they illustrate that tens/hundreds of thousands of dollars can go into useless procedures. As I alluded to before, in my opion, there are better uses for the health care dollar.
Cop Car
So copcar, if I found a lump in my breast or say my doctor had with the last physical, you would say there should be no exploration of what it might be? Have the medical system tell me to let it be and hope for the best? That is the real question because with a mammogram costing $100, it's not the cost factor. It's looking at what a lump might be. I have had several friends who had biopsies with no results. They didn't feel it was a waste of money but rather a relief that it was okay-- for that time.
My husband's aunt didn't have mammograms and when she saw her breast abnormality, it was a sunken area which was found to be cancer. She had a full mastectomy and radiation but it came back and she died a few years later. I don't know that a self exam would have found her lump earlier but she just didn't do them.
The thing is if doctors are not given the right to do a breast exam (don't forget it was part of this) and if what they regard as suspicious, is not permitted to be looked at, then all we will find is when it's late stages and that's definitely not cheap to treat or do we not treat it either?
I am not sure what tests would be more worthy to pay for than the mammograms which are cheap, and, as Fran mentioned above, as have many others, does catch cancers which can be removed hopefully before they become catastrophic.
This one task force does not prove that it's not a good thing to do mammograms regularly. It was looking at some data but when it added in self exams and your doctor doing one, it seems to me it lost credibility if it ever had any.
Reducing the number of mammograms prescribed does not equate to ignoring a symptom (lump) when found, Rain. Far from it. It is applying diagnostic tools, thoughfully.
CC
but it did equate to it, CC. Basically when they said women should not examine their breasts nor should doctors during a routine physical, that was about not finding lumps period. The cost of a mammogram is very low. It's not where their emphasis for concern was. It was in finding something. Those women who walk out with no further exam are not who concerned them. It was those where a doctor needed a biopsy to be sure it wasn't cancer. The task force said they don't want the lumps found by their own reasoning. When they are found, when they must be checked, it's what costs money if it can't be done by an ultrasound as twice mine were. So we save money as a nation by not finding them and too bad for the few women where finding them might have saved their lives?
I have heard the argument that they don't do the yearly scans for women under 70 in Europe but then you come back to the argument the Republicans are making-- that they are saving that money as part of their universal coverage. Sacrifice a few lives so that other women may have better care? It doesn't seem that should be the solution to me as those 'few' lives are our mothers, daughters, friends.
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