Wednesday, November 18, 2009

Keeping A-Breast of Change

On November 16th, a federal advisory panel (U.S. Preventive Services Task Force) suggested that unless a woman had a special susceptibility to breast cancer, routine mammograms for women in their 40s were unnecessary; only one life in 1904 women was saved by this procedure. Women were told to move that routine practice into their lives after age 50. As my wife was about to take her annual 60 mile breast cancer awareness/fund-raiser walk in San Diego under the sponsorship of the Dallas-based Susan G. Komen for the Cure foundation, the news was greeted by outrage and anger; two of her closest friends had mastectomies this month – both were in their 40s.

There’s a lot in the news, as healthcare reform sits high on the Obama administration’s agenda priorities, and there has been lots of press including recent blogs by me, about the staggering waste of “litigation-avoiding” defensive medicine, whereby doctors order a battery of unnecessary tests as a shield against a zealous malpractice lawsuit – just in case. That, when combined with doctors ordering expensive procedures from test-centers in which they have an ownership interest, has drawn an angry bead of ire from those seeking radically to reduce medical costs in this country – a nation where for the most part, doctors and hospitals are rewarded with more payments the more they order additional “procedures.” The suggestion is that perhaps breast cancer screening before age 50 is such a wasteful process.

For women in their 30s trying to figure out if they should proceed and women already in their 40s who have endured the painful mammograms, maybe the news that they don’t have to go through that procedure is something they want to hear. And if we can make this common practice of screening women in the 40s for breast cancer slowly disappear in future generations (but we could actually find a cure for this disfiguring, life-threatened disease!), think of all the money we’ll save… perhaps creating just a few additional job openings along the way.

I can promise you that those organizations created to battle cancer are, unfortunately, going to have to divert precious money from research-directed expenditures back into undoing the government’s message. If you know, are or have been someone with breast cancer, I suspect you are grateful that people are trying to stop this killer early in its growth to save lives and minimize disfigurement.

The news from the feds hasn’t impacted the plans of many, as this New York Times quote (Nov. 18) suggests: “Several doctors said that while they understood the panel’s risk-benefit analysis, their patients would not see it that way. ‘My patients tell me they can live with a little anxiety and distress but they can’t live with a little cancer,’ said Dr. Carolyn Runowicz, director of the Neag Comprehensive Cancer Center at the University of Connecticut…. ‘It’s kind of hard to suggest that we should stop examining our patients and screening them,’ said Dr. Annekathryn Goodman, director of the fellowship program in gynecological oncology at Massachusetts General Hospital. ‘I would be cautious about changing a practice that seems to work’…

“Most of the doctors, however, said they would inform younger women that the recommendations said they did not need mammograms if they were low-risk. They said they would also point out that groups like the American Cancer Society and the American College of Obstetricians and Gynecologists are sticking to the earlier guidelines.”

For those thousands and thousands of individuals making their annual Susan G. Komen walks, at various times and in various cities across the U.S., keep your heads on high; you fight the noble fight. And take heart in this statement in the November 18 New York Times: “Health and Human Services Secretary Kathleen Sebelius … issued a strong statement intended to put distance between federal policy and an influential panel’s recommendations that most women should start regular breast cancer screening at age 50, not 40… ‘There is no question that the U.S. Preventive Services Task Force Recommendations have caused a great deal of confusion and worry among women and their families across this country. I want to address that confusion head on. The U.S. Preventive Services Task Force is an outside independent panel of doctors and scientists who make recommendations. They do not set federal policy and they don’t determine what services are covered by the federal government. … 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. 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.’”

I’m Peter Dekom, and this was an easy one.

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