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Task force opposes routine mammograms for women age 40-49
Posted: 16 November 2009 05:16 PM   [ Ignore ]
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“Women in their 40s should not get routine mammograms for early detection of breast cancer, according to updated guidelines set forth by the U.S. Preventive Services Task Force.”

“All we are saying is, at age 40, a woman should make an appointment with her doctor and have a conversation about the benefits and harms of having a mammography now versus waiting to age 50,” said Dr. Diana Petitti, vice chair of the task force. While roughly 15 percent of women in their 40s detect breast cancer through mammography, many other women experience false positives, anxiety, and unnecessary biopsies as a result of the test, according to data.”

American Cancer Society disagrees! “With its new recommendations, the [task force] is essentially telling women that mammography at age 40 to 49 saves lives; just not enough of them,” Dr. Otis Brawley, chief medical officer for the American Cancer Society.” “Others fear insurance coverage of mammograms could be dropped based on the new recommendations.”

I suppose recommendations would be quite different for someone who has a strong family history of breast cancer, or other risk factors? Hey if I can avoid getting very painfully squished I’m all for it, but I’d also want to know that it wasn’t putting me at risk. I think that, as always, I’ll ask my doctor what she feels is best.


Article: http://www.cnn.com/2009/HEALTH/11/16/mammography.recommendation.changes/index.html

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Posted: 16 November 2009 10:52 PM   [ Ignore ]   [ # 1 ]
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Let’s see, if we assume that there are as many false positives as true positives, 15% each, (and that’s a big assumption) then we can say that half of the women who are told they test positive for cancer do have it.  If I were told initial tests showed that I have a 50% chance of having cancer, I’d damned well want a biopsy, and wouldn’t think of it as “unnecessary”. 

And who the hell is the U.S. Preventive Services Task Force?  I love those official sounding names for woo organizations.  Of course, even if they are making the statistics up, it’s a convenient fairytale that the insurance companies can latch on to to collect premiums but supply less service.

And while rectal prostate exams aren’t painful as are mammograms, they aren’t particularly pleasant (well maybe for some smile ), but I was certainly willing to go through them for a few years, especially when the urologist found some lumps that turned out to be malignant.  I suppose those people would object to men having that kind of exam because it is psychologically distressing.

Occam

[ Edited: 16 November 2009 10:56 PM by Occam ]
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Posted: 17 November 2009 06:13 AM   [ Ignore ]   [ # 2 ]
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Occam, this Task Force is a Panel of Analysts and Experts from the industry and science, put together by the Dept. of Health and Human Services.

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Posted: 17 November 2009 09:21 AM   [ Ignore ]   [ # 3 ]
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They appear to be a legitimate panel, but I’m curious why no oncologist was included in the panel for the decision.

I was happy to read that the new recommendations do not apply to any women with a family history of breast cancer, or high risk factors due to lifestyle or genes. Those women are advised to continue their annual mammograms at a younger age and more frequent intervals.

I get to see my annual lady-doctor later today (Joy oh joy! My favorite day of the year! rolleyes at least she has a great sense of humor.) I’ll try to remember to ask her what she thinks of the new recommendations. Although I might be a bit… distracted. I may forget.

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Posted: 17 November 2009 10:20 AM   [ Ignore ]   [ # 4 ]
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Death Panel!  vampire

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Posted: 17 November 2009 10:36 AM   [ Ignore ]   [ # 5 ]
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According to Fox News, it seems this is our first death panel!  LOL

They still recommend annual mammograms for women with high risk factors starting at age 40, they’re just advising that women with LOW risk factors that they can choose begin later and have mammograms less frequently. And they state that it’s up to the doctor and patient to determine what their risk factors are and what they are comfortable with.

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Posted: 17 November 2009 11:44 AM   [ Ignore ]   [ # 6 ]
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If we could just get rid of all Panels we could Stamp Out Death in Our Time!

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Posted: 17 November 2009 01:03 PM   [ Ignore ]   [ # 7 ]
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Actually, the new recommendation is based on some recent papers suggesting that screening in the absence of certain risk factors (genetics, age, family Hx and so on) may cause more harm than benefit. HERE is the most recent in a series of essays on the subject at Science-based Medicine.

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Posted: 17 November 2009 02:50 PM   [ Ignore ]   [ # 8 ]
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HERE are some details on the evidence basis of the new recommendations.

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Posted: 17 November 2009 05:56 PM   [ Ignore ]   [ # 9 ]
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VYAZMA - 17 November 2009 11:44 AM

If we could just get rid of all Panels we could Stamp Out Death in Our Time!

Now THAT was funny.  LOL

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Posted: 17 November 2009 06:12 PM   [ Ignore ]   [ # 10 ]
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mckenzievmd - 17 November 2009 01:03 PM

Actually, the new recommendation is based on some recent papers suggesting that screening in the absence of certain risk factors (genetics, age, family Hx and so on) may cause more harm than benefit. HERE is the most recent in a series of essays on the subject at Science-based Medicine.

Excellent link, thanks! I haven’t been to Science Based Medicine’s site in a couple weeks. I really should check it out more regularly.

A few years ago, the guidelines for women’s pap tests changed as well. They said healthy women with repeatedly normal test results could be tested every three years instead of every one. My doctor continued testing me every year, because that is what she is comfortable with and has always done. I’ve never had a problem with insurance covering it.

I briefly mentioned mammograms to her at my exam today. She said “You still get your baseline images next year when you turn 35. Then, when you turn 40 we’ll discuss it again, although it doesn’t look like you fall into a high risk group. Regardless, we’ll revisit the question when you turn 40 and take it from there.” I’m confident in her, so I will go with what she recommends when the time comes.

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Posted: 18 November 2009 12:15 PM   [ Ignore ]   [ # 11 ]
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HERE is a detailed analysis of the new guidelines and some sensible commentary on the overall issue.

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Posted: 19 November 2009 09:39 AM   [ Ignore ]   [ # 12 ]
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This recommendation should have been made years ago. We have known for nearly 20 years that mammograms do nothing to prolong life or decrease moratality in women under the age of 50. The continued recommendation for mammograms in these women has been motivated by several forces.

1) Lack of a good screening test - There is no other effective screening technique and so doctors have continued to recommend mammograms
2) Observer bias - Every physician knows at least one and perhaps many patients who had a breast tumor detected on mammogram who was treated and is alive today. Human nature causes these doctors to assume that the mammogram saved the womans life when in fact we do not know that. She may have done just as well or better had the mammogram never been done, and the studies suggest that this is in fact the case.
3) Lawyers - Failure to diagnose breast cancer is the most common reason for lawsuits in the area where I practice and in many areas of the country. Even if a doctor feels that mammograms are not useful he/she would never deviate from what the public considers to be standard of care because he could never convince a jury that it was proper medicine not to do routine mammograms in a 45 yr old woman ( look at how the public is over reacting to this current recommendation)
4) Politics - many advocacy groups and even medical groups existence depends on people believing that we can empower patients and make a difference by doing a simple screening test. If that were not true it would threaten their existence and more importantly call in to question all their hard work

This was a good recommendation and hopefully it will get people and government thinking about where we are spending our limited (yes they are limited) health care dollars, but I suspect this will all degrade into a useless yelling match with heart wrenching anecdotal stories being played over and over on TV and words like rationing ruling the day and stifling the conversation.

[ Edited: 19 November 2009 09:56 AM by macgyver ]
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Posted: 19 November 2009 12:24 PM   [ Ignore ]   [ # 13 ]
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While I’ve been looking into these new recommendations with curiosity, and seeking to learn more while being slightly confused, older women in my large office are squawking over this like so many angry chickens. They were gathered around the coffee machine in a noisy flock.

They keep saying the same thing “Well my friend (Mary/Susan/Kathy) had a mammogram in her 40’s and it detected deadly breast cancer! She had NO risk factors! That mammogram saved her life! She’d be DEAD right now if she hadn’t had the mammogram!” I’ve haven’t seen these women so furious since McCain/Palin lost the election.

You’re right on target there - personal stories and popular opinion are going to make people claim that “death panels” and “healthcare rationing” are at work. I believe European standards for mammograms are age 50+. Of course that will lead people to claim this is proof that we’re turning into a socialist country - now we have socialist mammograms…

I guess it all comes down to having something, and then having it taken away, which angers people. But I don’t think anyone is saying you CAN’T have a mammogram if you want one, just that it’s not necessary if you’re in a low risk group.

Insurance companies are so far saying they are not going to “take them away” from women in their 40’s. I’m not too worried either way. I’ll just do what my doctor advises is right for my situation.

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Posted: 19 November 2009 05:19 PM   [ Ignore ]   [ # 14 ]
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I think the goal of this panel was to try and simply start a conversation on this issue.  I dont think they wanted or expected things to change over night and they wont. Its simply that we have to start looking at what the evidence really supports. Mackenzie and I often talk about evidence based medicine. This is a prefect example of trying to make decisions about good medical practices based on solid scientific evidence rather than intuition or “common sense”. The USPSTF which put out this recommendation is a highly respected organization with no axe to grind and no financial incentive to make these recommendations. I had hoped that an intelligent discussion would come out of this but judging by the reaction from the public, our elected officials, and even many doctors ( none of whom seem to have a cogent rationale to back up their objection) I’m pessimistic that anything constructive will come out of it.

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Posted: 19 November 2009 05:57 PM   [ Ignore ]   [ # 15 ]
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Jules - 17 November 2009 09:21 AM

They appear to be a legitimate panel, but I’m curious why no oncologist was included in the panel for the decision.

I was happy to read that the new recommendations do not apply to any women with a family history of breast cancer, or high risk factors due to lifestyle or genes. Those women are advised to continue their annual mammograms at a younger age and more frequent intervals.

I get to see my annual lady-doctor later today (Joy oh joy! My favorite day of the year! rolleyes at least she has a great sense of humor.) I’ll try to remember to ask her what she thinks of the new recommendations. Although I might be a bit… distracted. I may forget.

Yes, I’ll have to ask my dr what she thinks too, esp given that my mother was the first known case of breast cancer in our family.  My grandmother who was still living then, did not know of any other cases in the family.  Luckily my mother survived it and is going on years cancer free, minus one breast, but my dr had me to a baseline shortly after my mother recovered, which was when I was 34 and has had me do mammograms every years since I was 40.  I’m 43 now.

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