Obama Hellcare Begins: Fewer Mammograms

[PeterS]

it doesn't save the gvt any money on medicare.... medicare is for seniors, not 40 or 50 year olds...

insurance companies changed their routine screening to 50 years old already....i noticed it on last year's insurance.

this has NOTHING to do with obama.... you guys are getting to the point of not being listened to anymore with all of your whining and FALSE claims of blame....why not save it, for when honestly deserved? too easy to blame all or your worries on to one person, eh?

Damn Care. Always the one with ration and reason. You really are a party pooper. My carrier dropped routine mammograms for under age 50 two years ago. We could still have me of course if we added a rider. My, my...

 

[Emma]

Thank you Mr Obama and democrats for this!!!

Thank President Reagan. The USPSTF has been around since 1984. They've based their recommendations on evidence-based practice and research. It's all about risk vs benefits. Guidelines for preventative screening have changed over the years. This isn't anything unusual or cause to get up in arms.

For every 1,000 women screened beginning at age 40, the modeling suggested that just about 0.7 deaths from breast cancer would be prevented, while about 470 additional women would receive a false-positive result and about 33 more would undergo unnecessary biopsies.

Almost half are false positives. That is very significant. No offense to the radiologist quoted in the OP, but he's way out of his league, and obviously didn't read the report.

The U.S. Preventive Services Task Force (USPSTF), first convened by the U.S. Public Health Service in 1984, and since 1998 sponsored by the Agency for Healthcare Research and Quality (AHRQ), is the leading independent panel of private-sector experts in prevention and primary care. The USPSTF conducts rigorous, impartial assessments of the scientific evidence for the effectiveness of a broad range of clinical preventive services, including screening, counseling, and preventive medications. Its recommendations are considered the "gold standard" for clinical preventive services.

The mission of the USPSTF is to evaluate the benefits of individual services based on age, gender, and risk factors for disease; make recommendations about which preventive services should be incorporated routinely into primary medical care and for which populations; and identify a research agenda for clinical preventive care.

Process
The Task Force makes its recommendations on the basis of explicit criteria. Recommendations issued by the USPSTF are intended for use in the primary care setting. The USPSTF recommendation statements present health care providers with information about the evidence behind each recommendation, allowing clinicians to make informed decisions about implementation.*

The USPSTF is supported by an Evidence-based Practice Center (EPC). Under contract to AHRQ, the EPC conducts systematic reviews of the evidence on specific topics in clinical prevention that serve as the scientific basis for USPSTF recommendations.

The USPSTF reviews the evidence, estimates the magnitude of benefits and harms for each preventive service, reaches consensus about the net benefit for each preventive service, and issues a recommendation.

The Task Force grades the strength of the evidence from "A" (strongly recommends), "B" (recommends), "C" (no recommendation for or against), "D" (recommends against), or "I" (insufficient evidence to recommend for or against).

"The new guidelines were based on a comprehensive analysis of medical literature that included an update of a Swedish study involving about 70,000 women, new results from a British trial involving more than 160,000 women and data from the Breast Cancer Surveillance Consortium about more than 600,000 women.

In addition, the task force commissioned an unusual study funded by the National Cancer Institute that involved six independent teams of researchers conducting separate mathematical modeling studies of the risks and benefits of 20 screening strategies."

Medicine is moving away from doing things "because we've always done it that way" and toward evidence-based practice. Regardless of what we've been conditioned to believe is the right way to go, these people examine the actual evidence and research to produce these guidelines.

Here are the actual guidelines:

Breast Cancer: Screening

Effects of Mammography Screening Under Different Screening Schedules: Model Estimates of Potential Benefits and Harms

In addition to examining other research/trials, they commission their own:

This work was done by 6 independent modeling teams from Dana-Farber Cancer Institute; Erasmus University; Georgetown University Medical Center, Lombardi Comprehensive Cancer Center (Dr. Mandelblatt, principal investigator); Harvard School of Public Health, Harvard Medical School, Harvard Pilgrim Health Care/University of Wisconsin (Dr. Stout, principal investigator); M.D. Anderson Comprehensive Cancer Center (Dr. Berry, principal investigator); and Stanford University (Dr. Plevritis, principal investigator). Drs. Mandelblatt and Cronin were the writing and coordinating committee for the project; all other collaborators are listed in alphabetical order. Dr. Feuer was responsible for overall CISNET project direction.

Knowing how involved clinical research is, and how long it takes to propose the trial, conduct the trial, and collect and evaluate the results, I would suspect this began prior to Obama taking office. Regardless, this isn't a political issue.

 

[American Horse]

it doesn't save the gvt any money on medicare.... medicare is for seniors, not 40 or 50 year olds...

insurance companies changed their routine screening to 50 years old already....i noticed it on last year's insurance.

this has NOTHING to do with obama.... you guys are getting to the point of not being listened to anymore with all of your whining and FALSE claims of blame....why not save it, for when honestly deserved? too easy to blame all or your worries on to one person, eh?

It's to save money and to bring spending under control. Bringing spending under control is one of the rationales for the proposed HealthCare reform. This type of board decision is part and parcel of the proposed plan. The number of lives which could be lost because of a change like this one could be as high as 50,000 per year, more than the outrageous 47,000 lives claimed to be lost annually because of denial of health care to those who are uninsured for all their various reasons, both voluntarily and involuntarily.

 

[Emma]

It's to save money and to bring spending under control. Bringing spending under control is one of the rationales for the proposed HealthCare reform. This type of board decision is part and parcel of the proposed plan. The number of lives which could be lost because of a change like this one could be as high as 50,000 per year, more than the outrageous 47,000 lives claimed to be lost annually because of denial of health care to those who are uninsured for all their various reasons, both voluntarily and involuntarily.

Wrong, sorry. I'm still researching, but I'm willing to bet this study started long before the health care bill (that's obvious) and before Obama took office. This isn't about saving money. It's about risk vs benefits and research/evidence-based practice.

 

[Maple]

They want to cut down on prostrate cancer screening as well.

They figure screening won't stop you from getting it.

That's the rationale to everything.

Your gonna die anyway.

Who was it who wanted the sick to "die fast"? Wasn't that supposed to be the Republicans? Don't tell me we finally have bipartisan support for something!!!

Republicans want the sick to die fast? My, my how soon we for get Terri Schiavo. I always thought republicans wanted the sick to suffer indefinitely...

In reality it's the democrats who want women to die very young.

They raise that age limit to 50 and you are going to see thousands of young women in their 40's die of breast cancer. I can't tell you how many times I have seen women in their very early 40's come down with breast cancer and a mammogram caught it early and they were cured. My own sister included. 80% of women who are diagnosed with breast cancer have NO family history of the cancer.

If I had my way I would see women at the age of 35 get mammograms. But with the new Democratic health care plan you get a sense of what they are thinking when they do this. Get ready for the rationing. It's coming your way in the form of a train wreck and it will be a financial and personal disastor for many families.

 

[Emma]

Oh good grief.

Why do I even bother.

If I had my way I would see women at the age of 35 get mammograms.

What part of evidence-based practice, research, risk vs benefits and "For every 1,000 women screened beginning at age 40, the modeling suggested that just about 0.7 deaths from breast cancer would be prevented, while about 470 additional women would receive a false-positive result and about 33 more would undergo unnecessary biopsies." do you not get?

 

[Mr.Fitnah]

Yup, a taste of what is coming .
vaccine shortages and now shifting policies that hurt the poor.

 

[Emma]

To hell with it. This has nothing to do with the healthcare bill or Obama, but you all just believe what you will.

 

[American Horse]

It's to save money and to bring spending under control. Bringing spending under control is one of the rationales for the proposed HealthCare reform. This type of board decision is part and parcel of the proposed plan. The number of lives which could be lost because of a change like this one could be as high as 50,000 per year, more than the outrageous 47,000 lives claimed to be lost annually because of denial of health care to those who are uninsured for all their various reasons, both voluntarily and involuntarily.

Wrong, sorry. I'm still researching, but I'm willing to bet this study started long before the health care bill (that's obvious) and before Obama took office. This isn't about saving money. It's about risk vs benefits and research/evidence-based practice.

There are risks in having a mammorgram or an MRI? I wasn't aware of that. One thing is certain, if neither of those two options is available before 50 it's certain that a much larger number of women will die of undiscovered cancer. I don't know how valid it is but I heard it from a responsible commentator that the number could be as high as 50,000.

Here's a problem: once the healthcare act goes into effect, the only options available will be those permitted by the covered plans which will be determined by the cost as regulated by the govt.. Right now doctors who take on Medicare patients can not treat them outside the medicare structure. That same regimen will apply across the board to enrollees. There will become two tiers of medicine available in this country and it will be defined in just that way.

 

[Emma]

It's to save money and to bring spending under control. Bringing spending under control is one of the rationales for the proposed HealthCare reform. This type of board decision is part and parcel of the proposed plan. The number of lives which could be lost because of a change like this one could be as high as 50,000 per year, more than the outrageous 47,000 lives claimed to be lost annually because of denial of health care to those who are uninsured for all their various reasons, both voluntarily and involuntarily.

Wrong, sorry. I'm still researching, but I'm willing to bet this study started long before the health care bill (that's obvious) and before Obama took office. This isn't about saving money. It's about risk vs benefits and research/evidence-based practice.

There are risks in having a mammorgram or an MRI? I wasn't aware of that. One thing is certain, if neither of those two options is available before 50 it's certain that a much larger number of women will die of undiscovered cancer. I don't know how valid it is but I heard it from a responsible commentator that the number could be as high as 50,000.

Again, sorry. But I take the word of these MD experts and their research over what a commentator says.

I linked to their report; please read it. In my opinion, the article in the OP didn't quite get it, but instead went the more sensationalized route (as the media is wont to do).

 

[Tech_Esq]

And what else does the article state?

washingtonpost.com


A spectrum of women's health advocates, breast cancer experts and public health researchers praised the new guidelines.

"It's about time," said Fran Visco, president of the National Breast Cancer Coalition, a Washington-based patient advocacy group. "Women deserve the truth -- and the truth is the evidence says this is not always helpful and can be harmful."

Susan Love, a well-known breast cancer expert at the University of California at Los Angeles, agreed. "I think that we've oversold early detection. We got carried away with a slogan," Love said. "We're not saying don't do it. Some women should get routine screening. But not all. We think in our society that more is always better. What we're saying is, 'It's not.' "

While the American Cancer Society said it has no plans to changes its guidelines, the National Cancer Institute said it would reevaluate its recommendations in light of the task force's conclusions.

The change is the latest development in a long controversy about mammography. The American Cancer Society and other groups have long recommended that women regularly undergo the tests every one or two years beginning at age 40 to catch tumors

Exactly OLD FOSSIL, the women are just health care abusers. They consume far too many health care resources just trying to avoid dying from cancer. Their numbers are too far out of line for society.

They, along with the real health care abusers, the old people (you might be one) need to reduce their profligate abuse of health care resources. If they refuse to do it voluntarily, we should impose costs and fees on them to reduce their overuse of this scarce resource. After all, we ALL need health care, they can't be consuming too much of it. Especially after we cover all of those new people when we have no additional doctors to care for them.

No sir, these women do not need all this testing! An OMG, what if they actually find a tumor in them they would just need treatment and consume more health care resources!!

We need to move quickly to the British system so we can reduce this over usage problem now! In Britain, you only get mammograms and pap smears between 50 and 70. Once every 3 years for mammograms and once every 5 years for pap smears. That's about right isn't it????? Who wants a bunch of old women running around anyway?

Why do they stop at 70? Well, if we aren't going to treat it, why should we test for it????

Bottom line.......LET'S END THE PROFLIGATE USE OF MEDICAL CARE NOW!!!!

 

[Tech_Esq]

It's to save money and to bring spending under control. Bringing spending under control is one of the rationales for the proposed HealthCare reform. This type of board decision is part and parcel of the proposed plan. The number of lives which could be lost because of a change like this one could be as high as 50,000 per year, more than the outrageous 47,000 lives claimed to be lost annually because of denial of health care to those who are uninsured for all their various reasons, both voluntarily and involuntarily.

Wrong, sorry. I'm still researching, but I'm willing to bet this study started long before the health care bill (that's obvious) and before Obama took office. This isn't about saving money. It's about risk vs benefits and research/evidence-based practice.

The point is still the same. It doesn't matter what the current political situation is. This report was created to have support for rationing. It doesn't really matter who uses it, insurance companies or the government.

The main difference is that at least you can fight the insurance companies a little. You can't fight the government at all. But, if you want to make the case for having fewer choices available to you when you are trying to save your life, then feel free.

I'm sure the fact that 50% were false positives will be a real comfort to you should you find yourself on the wrong side of the 50% and you were not tested. Now you are stuck with advanced stage cancer and little hope of any realistic treatment.

But, on the bright side, I guess you will do us all a real big favor and just die fast (you won't have much of a choice). Although, I'm sure the government health care bureaucrats will authorize any pain-killer you would like to take as you body is eaten from within.

 

[JenyEliza]

This is a certain death sentence for *many* American women.

I'm sad, but unsurprised to see this development under the Obama adminstration.

Here's Obama care.

Like they say....careful what you wish for, you might get it.

 

[American Horse]

Wrong, sorry. I'm still researching, but I'm willing to bet this study started long before the health care bill (that's obvious) and before Obama took office. This isn't about saving money. It's about risk vs benefits and research/evidence-based practice.

There are risks in having a mammorgram or an MRI? I wasn't aware of that. One thing is certain, if neither of those two options is available before 50 it's certain that a much larger number of women will die of undiscovered cancer. I don't know how valid it is but I heard it from a responsible commentator that the number could be as high as 50,000.

Again, sorry. But I take the word of these MD experts and their research over what a commentator says.

I linked to their report; please read it. In my opinion, the article in the OP didn't quite get it, but instead went the more sensationalized route (as the media is wont to do).

I read it, and I found parts of it to be ambiguous. I don't feel copetent to argue the points, but I will be interested in the informed debate that arises from this.

 

[geauxtohell]

Oh good grief.

Why do I even bother.

If I had my way I would see women at the age of 35 get mammograms.

What part of evidence-based practice, research, risk vs benefits and "For every 1,000 women screened beginning at age 40, the modeling suggested that just about 0.7 deaths from breast cancer would be prevented, while about 470 additional women would receive a false-positive result and about 33 more would undergo unnecessary biopsies." do you not get?

Well, if conventional medicine is resistant to evidenced based practices, it shouldn't be surprising that board posters are too.

Though, they probably have no idea how it's contributed to their health and well being.

 

[geauxtohell]

There are risks in having a mammorgram or an MRI?

Yeah.

It's called radiation.

 

[Emma]

There are risks in having a mammorgram or an MRI?

Yeah.

It's called radiation.

And, as the article states, unnecessary diagnostics and treatments (ironically some of which can increase one's chances of a cancer). I'll be honest here... I had no idea mammograms had such a high incidence of false-positives.

 

[Emma]

Oh good grief.

Why do I even bother.

If I had my way I would see women at the age of 35 get mammograms.

What part of evidence-based practice, research, risk vs benefits and "For every 1,000 women screened beginning at age 40, the modeling suggested that just about 0.7 deaths from breast cancer would be prevented, while about 470 additional women would receive a false-positive result and about 33 more would undergo unnecessary biopsies." do you not get?

Well, if conventional medicine is resistant to evidenced based practices, it shouldn't be surprising that board posters are too.

Though, they probably have no idea how it's contributed to their health and well being.

Well, resistance combined with partisanship. If I can't find a citation as to when this study began, I may just make a phone call

 

[geauxtohell]

There are risks in having a mammorgram or an MRI?

Yeah.

It's called radiation.

And, as the article states, unnecessary diagnostics and treatments (ironically some of which can increase one's chances of a cancer). I'll be honest here... I had no idea mammograms had such a high incidence of false-positives.

I don't think people can really grasp this without understanding the concept of sensitivity and specificity. It's why the rapid flu test is only useful for a positive diagnosis.

There is a lot of innumeracy on this thread.

It's not that screening for prostate cancer is useless, it's just that after a certain age, the risk of treating prostate cancer far outweighs the risk of dying from it.

As I said, most posters in here aren't aware of it, but the post-menopausal women posters on here who are no longer on estrogen and who are no longer in danger of keeling over from a cardiac event would theoretically be grateful if they knew what evidence based medicine did for them.

For anyone else that is interested in education:

CEBM > Home

 

[geauxtohell]

Oh good grief.

Why do I even bother.

What part of evidence-based practice, research, risk vs benefits and "For every 1,000 women screened beginning at age 40, the modeling suggested that just about 0.7 deaths from breast cancer would be prevented, while about 470 additional women would receive a false-positive result and about 33 more would undergo unnecessary biopsies." do you not get?

Well, if conventional medicine is resistant to evidenced based practices, it shouldn't be surprising that board posters are too.

Though, they probably have no idea how it's contributed to their health and well being.

Well, resistance combined with partisanship. If I can't find a citation as to when this study began, I may just make a phone call

I found this:

Screening for Breast Cancer: Recommendations and Rationale

Looks like most of the data and rationale are there.

Which means it won't be read by any of the outrage pimps on this thread.