Tuesday, November 17, 2009

Death Panel Preview? Influential Federal Task Force Recommends Against Routine Mammograms [UPDATED]

Sound medicine with a basis in health-related concerns, or cost rationing?
Women in their 40s should stop routinely having annual mammograms and older women should cut back to one scheduled exam every other year, an influential federal task force has concluded, challenging the use of one of the most common medical tests.

In its first reevaluation of breast cancer screening since 2002, the independent government-appointed panel recommended the changes, citing evidence that the potential harm to women having annual exams beginning at age 40 outweighs the benefit.

Coming amid a highly charged national debate over health-care reform and simmering suspicions about the possibility of rationing medical services, the recommendations immediately became enveloped in controversy.


But the American Cancer Society, the American College of Radiology and other experts condemned the change, saying the benefits of routine mammography have been clearly demonstrated and play a key role in reducing the number of mastectomies and the death toll from one of the most common cancers.

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


Some questioned whether the new guidelines were designed more to control spending than to improve health. In addition to prompting fewer doctors to recommend mammograms to their patients, they worried that the move would prompt insurers to deny coverage for many mammograms.

The new recommendations took on added significance because under health-care reform legislation pending in Congress, the conclusions of the 16-member task force would set standards for what preventive services insurance plans would be required to cover at little or no cost.

(emphasis added)

Ed Morrissey points out that this latest recommendation is a reversal from just 6 months ago, and posits a reason for the change:
What a difference six months — and a health-care overhaul proposal — can make! Just six months ago, the U.S Preventive Services Task Force, which works within the Department of Health and Human Services as a “best practice” panel on prevention, sounded a warning signal over a slight decline in annual mammograms among women in their 40s. In fact, they warned women of this age bracket that they could be risking their lives if they didn’t get the annual preventive exam ...


What changed in six months to change the USPSTF from a sky-is-falling hysteric on a 1% decline in testing to Emily Litella? If the administration gets its way, the government will be paying for a lot more of these exams when ObamaCare passes. That will put a serious strain on resources, especially since many of the providers will look to avoid dealing with government-managed care and its poor compensation rates.

The motivation for HHS will be to cut costs, not to save lives. The sudden reversal in six months of the USPSTF, especially after it made such a stink over a relatively minor decline in screening, certainly makes it appear that they have other priorities than life-saving in mind here.

One final thought. Barack Obama predicated his ObamaCare vision on the notion that increased prevention would save costs. Suddenly, his administration is for decreased screening and prevention. Could that have anything to do with the CBO scoring on screening? And what does that say about how government will make decisions once they control the compensation and care in the US?

UPDATE #2 (18 November)
Dr. Denise Hunnell (aka Catholic Mom) disagrees that the change in recommenations was politically motivated - "New mammogram recommendations are actually a victory of science over politics":
... It would be a mistake to lump this analysis in with the Obamacare rationing arguments. The lack of efficacy in breast self-exams and the questionable benefit of mammograms for women in their forties is not new information. This has been known for at least a decade. Ten years ago I got dirty looks at a coffee klatch when a woman was lamenting the death of one of our neighbors from breast cancer and exhorting us to make sure we were doing our breast exams. I probably should have kept my mouth shut, but the scientist in me had to mention that the evidence did not back up the efficacy of regular breast self-exams.

It is important to understand that the new mammogram recommendations pertain to women who have no increased risk factors like a family history or known genetic mutations. The USPSTF now says that women should not begin mammogram testing until age 50. Women in their forties face a higher risk from the testing than they do from breast cancer. Most screening tests are going to be negative. A significant number of the positive tests are false positives. A positive test requires follow-up testing. This follow up testing is much more invasive than the screening test and has risks. Biopsies are surgical procedures. Surgery is never risk free.

Understand as well that the previous recommendations were not based on science. They were the result of medical politics...

[Read the whole thing]
Knowing her strong views against health-care rationing, I am inclined to find Dr. Hunnell's analysis of this issue persuasive.

Previous Pro Ecclesia posts on this subject:
Palin Upstages President Again on Death Panels: "Obama and the Bureaucratization of Health Care" [UPDATED]

More Evidence that Palin Right on "Death Panels"

At the Head of the Table: Churchill, Kennedy, & Palin

Obama's Health Rationer-in-Chief: Hippocratic Oath Responsible for "Too Much" Medical Care

Andy McCarthy and Mark Stein Slap the Handwringing Girly Boys in Charge Over at National Review: Palin Was Right On the "Death Panels" [UPDATED]

Sarah Palin Right About Obama "Death Panels"

Health-Care Rationing Violates Catholic Teaching



At 11/18/2009 10:17 AM, Blogger Denise said...

Jay, please take a look at my piece here. As a family physician, I have watched this debate about the efficacy of mammograms for women in their forties for over a decade. The original recommendations made no sense from a scientific standpoint. The extension of screening to women in their 40's was a political nod to the radiologists and surgeons who would benefit financially. Now there is evidence that the hazards of screening due to follow up invasive testing of false positive results are a greater risk than the disease (breast cancer) being screened. I am stridently against Obamacare, but I think it is a rush to judgment to call these recommendation part of the Obamacare rationing plan.


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