Breast Cancer and Health Care.

The problem with the new guidelines from the United States Preventative Services Task Force recommending only biannual mammograms for most women once they reach age 50, rather than annual ones for all women over 40, is that we all believe doctors should perform test after endless test and that, if they do, they can always save our lives. I blame it all on Fox’s hit House, and on Hugh Laurie’s devilish charm.

The faith in tests and the ability of the medical system to always stop death may explain why so many doctors and insurance companies are already objecting to the new standards. We just don’t believe it’s not better to screen. That idea is so ingrained that I heard someone chatting on NPR about how the panel’s study did not account for digital screening over older methods, but the panel did say there was not evidence that digital screeners performed any better than older tools. Rachael Larimore over at Double X (or XXFactor, whatever it is now) called it early health care rationing. Get ready ladies, no more preventative screening for us.* 

All of this undermines the findings of the panel, which pointed out how real the risks of overtreatment are. We tend to want to stop cancer at all costs, but every time we let a surgeon cut us, there’s the potential for harm. That doesn’t count costs that might seem mundane in life or death situations, like the co-pays for uninsured women, which really matter for a woman on the edge of solvency. If she’s much poorer in the ensuing years, that might harm her health, too. The truth is, reducing the breast cancer rate by 15 percent for the 40 to 50 age group might not be worth the harm it does to other women.

Try telling that to the 15 percent who might have their lives saved. The problem is, everyone personally knows of a woman who got breast cancer at weirdly young age and had no risk factors. She either was saved or not. Either way you laud or blame the doctors involved, but things are a lot more open to chance and human ability than we care to admit. 

As Igor Volsky pointed out over at The Wonk Room, this might have broader implications for the kind of comparative effectiveness research policy-makers hope will be part of health care reform. When Americans are asked, they might say that people have a right to health care whether they can afford it or not, but I’ve yet to meet anyone who says that the health care of the entire nation is more important than their own health or the health of their families.** Maybe that explains that, while people polled support the idea of reform, many people think it’ll make their own situation worse. If you’re lucky enough to have employer-provided health care, which the majority of Americans still are, the kinds of health care concessions you make might seem to be in your control. The government is just more open about the fact that concessions are necessary than private insurance companies are. It all depends on which kind of imperfect situation you think is better. We know what science  tells us, but it’s a hard sell.

*  Incidentally, studies found a few years ago that doctors perform too many pap tests, too.

** This isn’t unique to Americans.

  • aisha

    The problem I have with the study is the part about self breast exams. Are the costs associated with them really that costly that we need to do away with self detection? So we are saying to do away with all forms of detection for those under 50? That doesn’t make any sense.

    Overall this study was a test for one of my main issues with the current health reform. We aren’t reforming healthcare if we don’t deal with cost and access. This report recommends some things that will lower healthcare cost (upfront). So I should be on board.

    Then the emotional part of me remembers that my mother was diagnosed with breast cancer at 35 went into remission for 21 years and died of breast cancer at 56.

    At the end of the day it’s up to each woman to decide with her doctor what to do. I’m 31 and I get a mammogram every 2 years and continue to do so.

  • keke

    I have a few problems with the way the results of this study was trotted out. I don’t feel that enough ground work was done to prepare women for the new recommended guidelines.

    I know that there are studies out there that pretty much knock the use of self breast examinations. Even so, it does not cost a woman anything to do self-breast examinations and it is important for women to know their breast. The self breast examination has been moving further away from the idea of searching for lumps; there has been more of a shift for women to just be aware of their bodies and recognize significant changes in their breasts which is very important.

    My biggest question is how does this information impact black women? White women are more likely to be diagnosed with breast cancer yet black women are more likely to die from breast cancer when we are diagnosed. So in light of the recommendation guidelines from this panel, what do we do about that disparity? For so long we have focused on the idea of early detection. Yet black women are less likely to have a primary care doctor, less likely to receive adequate service/screening, less likely to follow-up with a doctor after mammograms and are often diagnosed at a later stage.

    So should we focus on closing that disparity? Should we focus on better health care facilities and eliminating those barriers to access? Should we focus more on environment issues and healthy lifestyle changes? How do address the issue of the high mortality rates of black women diagnosed with breast cancer?

    This is also a very emotional issue for me since my mother was diagnosed with breast cancer and died at the age of 45. When I heard the results, I was startled. I have no problem with science and I recognize the need for changes in the USA health care system and cutting costs ….but I cannot help but think of how this shift guidelines can may have a huge negative impact on black women and breast cancer diagnosis if some broader issues are not addressed.