Obama Hellcare Begins: Fewer Mammograms

[Emma]

I skimmed the report I linked above; perhaps tomorrow when I'm not cross-eyed and half asleep, I'll dig in a bit deeper.

 

[geauxtohell]

I skimmed the report I linked above; perhaps tomorrow when I'm not cross-eyed and half asleep, I'll dig in a bit deeper.

Yeah, I am with you.

 

[Emma]

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.

Thanks. That might be the prior recommendations, though, because it's recommending mammograms >age 40.

Health Care: Guide to Clinical Preventive Services, Subdirectory Page

 

[keee keee]

Thats it the government will be doing you a favor by rationing or denieing you treatment, by saying they where keeping you from getting radiation poisoning by doing mamograms or mri's, the test and rationing didn't kill you the cancer did, but the good thing is you didn't get radiation poisoning!!! Isn't Obama care great!!!

 

[Emma]

Well, GTH... you were right

 

[Emma]

This is the same attitude docs have to deal with when their patients get all bent out of shape when told they are NOT going to get an antibiotic just because they're "sick"... and then wonder why MRSA and other DROs are fast becoming the norm.

 

[Emma]

Health Care: Evidence-based Practice Subdirectory Page

 

[Maple]

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.

You won't need to worry about Palin taking women votes from the democratic party if this passes that's all they are going to need to switch. I walk for the cure every year and every year across the country there are thousands upon thousands of breast cancer survivors that had they not had that mammogram in their 40's would not be here today. This will anger many thousands of women even the democratic Obama supporters or I should say former supporters.

 

[Emma]

1. This has nothing to do with Obama or the healthcare bill that just passed the House. As I said, this study was most likely started before Obama took office (and most certainly before the bill was written).

2. However, you're probably right, since too many (as evidenced on this thread) don't seem to understand what this report is about, or why they're making these recommendations.

3. I'm a cancer survivor, I've had relatives with cancer, and these changes in recommendations for screening don't alarm me. In fact, my Mom was one of those who had a false-positive mammogram, and ended up in surgery because of it.

 

[American Horse]

There are risks in having a mammorgram or an MRI?

Yeah.

It's called radiation.

OK, we can stipulate that x-ray radiation can cause cancer. But to not have Mammograms until 50? Why not have them every other year, or every third year from an early age, like the 30's. Not worth much, anecdotal as it is, but I know at least two women who died in their early 40's of breast cancer.

Occupational exposure for workers is limited to 5000 mrem per year. The dose of a resident of Denver Colorado is 500. For people living at sea level the ambient dose is about 250 mrem; mammogram 138 mrem per image

Office of Research Services (ORS) - Division of Radiation Safety (DRS)

But all that may be moot:

Now doctors have come up with a revolutionary new mammogram that is radiation and pain free! They are using ultrasound technology to detect tumors in the breast. Radiologists from the Karmanos Cancer Institute in Detroit, USA, suspend a woman’s breasts in water and fire ultrasound rays through them to generate images of the breast tissue. Not only is the new method pain free, it is said to be more accurate at picking up cancer than a traditional mammogram and uses no radiation so it’s safer for the patient.

Radiation Free Mammograms | EmpowHer - Women's Health Online

 

[Mr.Fitnah]

I skimmed the report I linked above; perhaps tomorrow when I'm not cross-eyed and half asleep, I'll dig in a bit deeper.

Have a steaming cup of koolaid that should keep the glazzys open.

 

[geauxtohell]

There are risks in having a mammorgram or an MRI?

Yeah.

It's called radiation.

OK, we can stipulate that x-ray radiation can cause cancer. But to not have Mammograms until 50? Why not have them every other year, or every third year from an early age, like the 30's. Not worth much, anecdotal as it is, but I know at least two women who died in their early 40's of breast cancer.

Occupational exposure for workers is limited to 5000 mrem per year. The dose of a resident of Denver Colorado is 500. For people living at sea level the ambient dose is about 250 mrem; mammogram 138 mrem per image

Office of Research Services (ORS) - Division of Radiation Safety (DRS)

But all that may be moot:

Now doctors have come up with a revolutionary new mammogram that is radiation and pain free! They are using ultrasound technology to detect tumors in the breast. Radiologists from the Karmanos Cancer Institute in Detroit, USA, suspend a woman’s breasts in water and fire ultrasound rays through them to generate images of the breast tissue. Not only is the new method pain free, it is said to be more accurate at picking up cancer than a traditional mammogram and uses no radiation so it’s safer for the patient.

Radiation Free Mammograms | EmpowHer - Women's Health Online

First, let's just drop the "obamacare" bullshit (I know you haven't really been a culprit in that), it's a falsehood.

Second, let's put this recommendation in the proper context: a recommendation. The U.S. Preventive Services Task Force simply makes recommendations. They don't make policy. In the end, it's up to Drs. to decide what screening protocols to follow. As noted in the article, the American Cancer Society disagrees. When it comes to "adult health maintenance" there are many divergent opinions on what screens should and should not be done and when. The ACA has a different set of guidelines. It's up to Drs. to follow (or health insurance companies to decide what they are paying for). I personally like the USPSTF (from a medical student's perspective) because they are evidenced based and have been ahead of the curve on many recommendations.

Now as for the rest of the question: Why 50? Because the outcomes support it. That's really what evidenced based medicine is about. In this instance, the USPSTF sees little benefit (and more risk) by starting at 40. As women age, their risk of breast cancer goes up. Somewhere along that continuum, lies the absolute most efficient place to start screening women for BC.

And that is their point, we are talking about routine screens. The kind that are checked in the "orders" box like ham and eggs just because a women comes in for a scheduled clinic visit and is over 40. That's it, that's the only two criteria. You mentioned your friends that had BC in their 40s. That assumes that a mammogram is the only way to catch breast cancer. If their Dr. palpated a mass (or they did), it would indicate a mammogram regardless of age.

People can talk about statistical outcomes and the "women who will die of breast cancer because of this), but by that rational, why not recommend every woman over 25 get a yearly mammogram? The specificity would be terrible (even worse than 40), but hey, we might catch them all! Or we might actually cause breast cancer by exposing women to radiation every year.

As noted, the USPTF looked at the specifity and sensitivity of annual mammograms to detect breast cancer as a routine screen and felt that 40 was counterproductive.

As much as I'd love to go into a numbers crunching discussion about sensitivity and specificity, I have a feeling that most people on this thread don't really care. They just want to use this as an excuse to bash Obama care, even when it has nothing to do with it.

 

[toomuchtime_]

There are risks in having a mammorgram or an MRI?

Yeah.

It's called radiation.

OK, we can stipulate that x-ray radiation can cause cancer. But to not have Mammograms until 50? Why not have them every other year, or every third year from an early age, like the 30's. Not worth much, anecdotal as it is, but I know at least two women who died in their early 40's of breast cancer.

Occupational exposure for workers is limited to 5000 mrem per year. The dose of a resident of Denver Colorado is 500. For people living at sea level the ambient dose is about 250 mrem; mammogram 138 mrem per image

Office of Research Services (ORS) - Division of Radiation Safety (DRS)

But all that may be moot:

Now doctors have come up with a revolutionary new mammogram that is radiation and pain free! They are using ultrasound technology to detect tumors in the breast. Radiologists from the Karmanos Cancer Institute in Detroit, USA, suspend a woman’s breasts in water and fire ultrasound rays through them to generate images of the breast tissue. Not only is the new method pain free, it is said to be more accurate at picking up cancer than a traditional mammogram and uses no radiation so it’s safer for the patient.

Radiation Free Mammograms | EmpowHer - Women's Health Online

Even with X-rays, the Preventive Services Task Force, which issued the new recommendations, acknowledges that there is a net benefit to women to starting mammograms at 40. Net benefit would mean that even taking into consideration the exposure to radiation and the biopsies caused by false positives, more lives would be saved by routine mammograms starting at age 40.

The USPSTF recommends against routine screening mammography in women aged 40 to 49 years. The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms.
Grade: C recommendation.

Breast Cancer: Screening

The grade of C means:

The USPSTF recommends against routinely providing the service. There may be considerations that support providing the service in an individual patient. There is at least moderate certainty that the net benefit is small.

Grade Definitions After May 2007

So the net benefit is small, but there is a net benefit. So why would they recommend against this procedures if there is net benefit? The answer to this question lies at the heart of the debate over whether we would be better off or worse off if government takes a more active role in health care as Obama and the Dems seem to want it to.

The Preventive Services Task Force recommends against this procedure while acknowledging it would save lives, even after discounting the possible harm from radiation exposure and biopsies caused by false positives, because it is looking at this situation from a public health perspective: is the net benefit great enough to justify the cost? The American Cancer Society recommends beginning mammograms at 40 because it is looking at this same situation from the perspective of an individual patient, which is what each of us would want our own doctors to do.

To the extent the government takes an active role in providing health care, it urge or try to force providers to treat their patients from a public health perspective because "too much" spending will make tax increases necessary and that might produce a voter backlash: a few additional deaths will turn off fewer voters than a tax increase. The professional colleges for the various medical specialties, on the other hand, develop protocols for treatment that are based on the best interests of the individual patient without the constraints of viewing resources as scarce as the government does.

This is where the fear of rationing of health care services comes from, and this is where the notion of "death panels" comes from. In this case, by recommending against a procedure it acknowledges would save lives, the Preventive Services Task Force is functioning as a death panel from the perspective of the individual patient but with the very best of intentions from a public health perspective.

 

[Cecilie1200]

We will be seeing all kinds of "recommendations" coming from the NIH "cost effectiveness" programs which will in turn ration care for all of us. Hello death panels.

My insurance carrier dropped routine mammograms 2 years ago. I guess they were just ahead of the curve...

So because you can't get decent coverage, the rest of us should by God have the same shitty coverage you do? Is that how it works? MY carrier has routine mammograms starting at 40, or even earlier if you have a family history of cancer.

 

[geauxtohell]

We will be seeing all kinds of "recommendations" coming from the NIH "cost effectiveness" programs which will in turn ration care for all of us. Hello death panels.

My insurance carrier dropped routine mammograms 2 years ago. I guess they were just ahead of the curve...

So because you can't get decent coverage, the rest of us should by God have the same shitty coverage you do? Is that how it works? MY carrier has routine mammograms starting at 40, or even earlier if you have a family history of cancer.

You realize that the USPSTF makes recommendations, not policy, right?

 

[American Horse]

First, let's just drop the "obamacare" bullshit (I know you haven't really been a culprit in that), it's a falsehood.

<SNIP>
As much as I'd love to go into a numbers crunching discussion about sensitivity and specificity, I have a feeling that most people on this thread don't really care. They just want to use this as an excuse to bash Obama care, even when it has nothing to do with it.

Actually I didn't, as you acknowledged, mention "Obama-Care" in any of my posts in this thread. But It would be accurate to give it that title since he campaigned for it, he asked for it, he has driven it, he will sign it (if it reaches his desk), so.... he will get credit or the blame for it. To call it by its rightful name does him no disservice, and serves to notify him and his of that fair attachment; it will, if it passes, along with the processes that play into it, always be known by that name.

 

[AllieBaba]

Mammograms suck shit anyway. Unless you have secondary symtoms, such as painful lumps, discharge, etc., they're completely useless.

If you do have some sort of symptom, they can identify lumps. Which can be identified anyway with an xray.

I don't do mammograms. We have a "boob bus" that carts all those willing to hop aboard to the nearest city for mammograms...they give them a free lunch to lure them in. Nobody has had their lives saved for this, or found anything they didn't know was there already.

I avoid mammograms like the plague. I also don't do colonoscopies and laugh at the women who line up like sheep to have a fucking metal probe stuck up their ass to look for whatever. The probes are a hundred times more dangerous than anything they might find. I know two people who have died as a result of "preventative" exploratories.....one from a colonoscopy which incidentally punctured his large intestine, resulted in a blood clot which killed him, and the other from having and exploratory surgery in his knee (he had knee pain and arthritis, bless his heart) which introduced a virulent staph infection that resulted in his death within days.

Thanks, I'm opting out. I don't feel any boob lumps nor am I bleeding from the ass. I prefer not to have it induced.

 

[veritas]

My immediate thought is that mammograms aren't very good tests if they yield that many false positives. In addition to that, they are expensive and unpleasant. So we need better, more cost effective testing.

 

[geauxtohell]

First, let's just drop the "obamacare" bullshit (I know you haven't really been a culprit in that), it's a falsehood.

<SNIP>
As much as I'd love to go into a numbers crunching discussion about sensitivity and specificity, I have a feeling that most people on this thread don't really care. They just want to use this as an excuse to bash Obama care, even when it has nothing to do with it.

Actually I didn't, as you acknowledged, mention "Obama-Care" in any of my posts in this thread. But It would be accurate to give it that title since he campaigned for it, he asked for it, he has driven it, he will sign it (if it reaches his desk), so.... he will get credit or the blame for it. To call it by its rightful name does him no disservice, and serves to notify him and his of that fair attachment; it will, if it passes, along with the processes that play into it, always be known by that name.

Obama has absolutely nothing to do with this recommendation, despite some people's best efforts to claim otherwise.

That was my point.

 

[California Girl]

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...

What is it with liberals and 'attention span'. Was it not one of the Democrats own who stood on the floor of the Senate and stated that 'die quickly' is the GOP healthcare plan.