Breasts: Victims of Sexist Policy or Beneficiaries of New Research?

For decades doctors have urged women to get frequent mammograms starting in their forties. When it comes to breast cancer—the second deadliest cancer for women—doctors have always advised women that early detection saves.

Today the U.S Preventive Services Task Force, a panel within the Department of Health and Human Services, marked a sharp withdrawal in policy promoting breast cancer awareness. According to new Task Force recommendations, women don’t need mammograms until they’re into their fifties. Women should hold off on mammograms until they hit 50, and even then they should cut back from the previously-recommended two mammograms annually to just one exam every other year.

Wait, WHAT?! Isn’t this the same Task Force that sounded an urgent alarm just six months ago, when statistics showed a slight decline–only 1%–in annual mammograms among women in their forties?  The same Task Force that cried out that women in this age bracket were risking their lives if they forgo annual exams?

The downward trend, however slight, has breast cancer experts worried. Mammograms can enable physicians to diagnose the disease at early stages, often before a lump can be felt. “When breast cancer is detected early, it often can be treated before it has a chance to spread in the body and increase the risk of dying from the disease,” says Katherine Alley, medical director of the breast health program at Suburban Hospital in Bethesda.

The U.S Preventive Services Task Force, an independent panel of experts working under the Department of Health and Human Services, recommends that women older than 40 get a mammogram every one to two years. The task force finds the test most helpful for women between ages 50 and 69, for whom it says the evidence is strongest that screening lowers death rates from breast cancer. Other groups, including the American Medical Association, suggest a more rigorous schedule, saying the test should be done every year; insurers often pay for annual tests.

But experts say they are seeing gaps beyond two years in many cases. Carol Lee, chair of the American College of Radiology’s Breast Imaging Commission and a radiologist at the Memorial Sloan-Kettering Cancer Center in New York, says many women understand that they need to have a mammogram but don’t go back for repeat tests after the first one. In Bethesda, Alley said she has even heard anecdotal reports of breast cancer survivors forgoing recommended mammograms.

How could breasts have changed so much in six months? Or is it women in their forties who have changed? Ah, that’s right too—it was health care that changed. A mere six months after panicking over a mere one percent decline in mammograms among the forty-something set, today the Task Force issued an abrupt about-face:

“We’re not saying women shouldn’t get screened. Screening does save lives,” said Diana B. Petitti, vice chairman of the U.S. Preventive Services Task Force, which released the recommendations Monday in a paper being published in Tuesday’s Annals of Internal Medicine. “But we are recommending against routine screening. There are important and serious negatives or harms that need to be considered carefully.”

Several patient advocacy groups and many breast cancer experts welcomed the new guidelines, saying they represent a growing recognition that more testing, exams and treatment are not always beneficial and, in fact, can harm patients. Mammograms produce false-positive results in about 10 percent of cases, causing anxiety and often prompting women to undergo unnecessary follow-up tests, sometimes-disfiguring biopsies and unneeded treatment, including surgery, radiation and chemotherapy.

But the American Cancer Society, the American College of Radiology and other experts condemned the change, saying the benefits of routine mammography have been clearly demonstrated and play a key role in reducing the number of mastectomies and the death toll from one of the most common cancers.
“Tens of thousands of lives are being saved by mammography screening, and these idiots want to do away with it,” said Daniel B. Kopans, a radiology professor at Harvard Medical School. “It’s crazy — unethical, really.”

No, ladies, neither breasts nor women have changed in the last six months. What’s changed is that the Department of Health and Human Services is an agent of an administration suddenly responsible for paying for these exams once ObamaCare passes.  This public health care omnibus claims it will shoulder the cost of preventative exams. Mammograms represent the quintessential “preventative exam.” But rather than pay for the care doctors have long urged women to demand for themselves, the government is simply pressuring health officials to redefine what women need.

Government-rationed health care will put a strain on resources like doctors and hospital space. Many providers will prove eager to avoid dealing with government-imposed conditions, red tape, and poor compensation rates. But rather than stand up and defend women’s efforts to protect themselves with preventative care, this government panel simply manipulates doctors’ advice to redefine what women need.  In fact, while more than half of the doctors behind these new recommendations are women, none are oncologists.  Nor is the Task Force a research organization; instead, it’s part of an agency under the Executive branch of the government, responsible for neither health nor research but rather implementing policy:

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

 

At least we know what bias to expect.  This is not a group of doctors acting on behalf of one patient at a time.  It’s a group of policy-minded clinicians attempting to ration a tax-funded government pot among every American needing care.  Women in their forties may not be ObamaCare’s top priority.  But advising women to stop getting checked redefines reckless and brings to light insidious danger women face under the public option.

Evidently the Department of Health and Human Services knows which side of its bread is buttered under the new health care bill! This administration promised to prioritize life-saving preventative care.  Instead, less than two weeks after ObamaCare passed in the House, public health officials have begun rolling back decades worth of doctors’ wisdom.

So the elderly won’t be the first to get thrown under the public health care bus — it’s women.

At The New Agenda.

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