Which lives aren’t worth saving? / LJWorld.com

Archive for Monday, November 23, 2009

By Lynne K. Varner - The Seattle Times

November 23, 2009

Obviously, I am not more knowledgeable about breast cancer than a government-led panel of experts. Yet I know enough to look askance at advice that only women 50 and older get mammograms every two years and those in their 40s skip the test altogether.

New cancer-screening guidelines, published in the Annals of Internal Medicine, fly in the face of conventional wisdom and long-standing consensus from cancer groups, radiologists and other experts that women get annual mammograms starting at age 40.

Science routinely second-guesses itself and women have often been caught in the middle. The controversy about estrogen-replacement therapy is one example where women were forced to weigh conflicting medical advice.

Moreover, the U.S. Preventive Services Task Force isn’t nixing mammograms. They acknowledge the test’s early detection benefits.

But here’s what galls me: Not enough lives are saved, the experts say, to justify mammography as a routine screener for breast cancer.

Here’s a question: Of the lives saved by mammograms, which ones weren’t worth the effort? Certainly my sister’s life — saved not only by a mammogram’s detection of something amiss, but by subsequent biopsies, surgeries and rounds of chemotherapy — was worth the effort and more.

But, says the panel of experts, mammograms’ potential for harm outweigh their benefits. In about 10 percent of cases, they produce false-positive results, leading women to undergo unnecessary follow-up tests such as biopsies, and in worst-case scenarios, surgery, radiation and chemotherapy.

Women are not to blame for false-positive readings. The solution is not to take away a woman’s choice to have a mammogram, but rather to work to reduce the rate of false readings.

I can only imagine that if men were experiencing abnormally high rates of false positives on tests for testicular cancer, heads would be rolling in radiology departments nationwide.

Mammograms are not a walk in the park. I speak with experience as fresh as last week when I rested against a chilly slab and experienced that familiar whack and intense pressure from a large machine built to flatten one’s chest to the width of a slice of pita bread.

Would I prefer to forgo this experience? Absolutely, which explains why my annual exams tend to get scheduled only after a friendly, firm reminder from my physician.

I don’t want to get mammograms. I have to. Spurring me on is not just my family narrative, but this reality: Breast cancer is the most commonly diagnosed cancer in American women, excluding skin cancer. It kills more women than any other cancer except lung cancer.

Last year, more than 182,000 American women were diagnosed with invasive breast cancer and 40,000 died of it.

If only those 40,000 women could be asked how they feel about being rescued from the trials of mammography. Better yet, how they feel about the guidelines’ advice to eschew monthly breast self-exams because they have not proven to reduce mortality from breast cancer.

Adding to my annoyance is this intrusion of politics into medicine. Under health-care-reform legislation in Congress, the new recommendations would help set standards for what preventive services insurance plans would be required to cover.

Have insurance companies just been given a green light to refuse to cover mammograms for women under 50? If so, at nearly $200 a test, working women and those who are low-income have been dealt a life-threatening blow.

I know science must operate in large statistical terms but people are not numbers. If the life saved by a mammogram is my own, I am more than justified in wanting early and routine screenings.

Discussion

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23 November 2009
at 8:23 a.m.

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SettingTheRecordStraight (Anonymous) says…

A portent of the unnecessary health care rationing that will be the norm under government medicine.
23 November 2009
at 6:30 p.m.

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davidburress (Anonymous) says…

It's hard to know how to respond to this kind of hysteria.

What the research shows is that having pre-50 mammograms ends up doing more damage to women than not having them. That's not only because of false positives, but also because of having operations on actual cancers that never would have killed the patient. The rate of growth of early cancers is simply not predictable. Having an operation in a hospital is innately dangerous; for example, a certain fraction of patients will get antibiotic-resistant infections. Putting it all together, doing mammogram screening before 50 is apparently more dangerous than not screening. Scientists published those facts because they care about women, not because they wanted to save money.

Varner responds with understandable but irrational rage at doctors for not getting everything right the first time. She wants to live in a world where everything is known in advance and science is perfect. In reality most scientists and doctors are already doing the best they can on dealing breast cancer. All tests have false positives, and blaming doctors for that is foolish. All procedures that work well in the testing phase can potentially turn out to do more harm than good once they are implemented. Blaming scientists for publishing that when they find out is counterproductive.

Therefore Varner's question “which lives are not worth saving” is deeply unfair. Doctors want to save every life they can. Varner is in denial about the fact that simply having a mammogram risks your life, because it may lead to a dangerous operation that was unnecessary. (Moreover there is no way to tell which particular operations were unnecessary—yet we can tell what percentage were unnecessary by comparing outcomes in otherwise similar groups with and without the operation.) Doctors are simply doing their best to decide when it more dangerous to have the mammogram, versus when it is more dangerous not to.

Then Varner really goes off the deep end with her comparison to men. She thinks doctors would have acted differently if men were involved. But in point of fact a similar change is going on right now in screening for prostate cancer. Research is showing that routine screening of PSA levels is often counterproductive, and doctors are starting to recommend against it.

Continuing in that paranoid vein, Varner somehow ties this all in to changes in national health insurance law. In reality insurance companies have always made judgments about which procedures are justified and which aren't, often unfairly so, and nothing being proposed in Congress is going to change that very much. The “death panel” lies have been debunked over and over again in the press, and even by some Republicans in Congress, but of course they are never going to be dropped by the radical right fringe.

David Burress
Ad Astra Institute
Lawrence KS
23 November 2009
at 6:42 p.m.

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leedavid (Anonymous) says…

Well so much for preventative medicine that this new healthcare bill is supposed to be about. David, I lost my wife to cancer. She was 51 and felt she did not need mammograms, she was too young, they were too invasive, hurt, a host of excuses. She sure bugged me about getting a physical every year. If she would have gotten mammograms they would have discovered the cancer before it spread to a point of ….. “Well let's just make her comfortable.” It was her choice, we had the healthcare, but the science says she would have had a chance had they caught it earlier. I have moved on. This is not about sympathy or anything else. But facts are facts, her life was worth living.
24 November 2009
at 7:56 a.m.

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merrill (Anonymous) says…

The most expensive medical insurance in the world is primarily concerned about profits. Consequently they are always searching for ways to reduce spending in an effort to encourage profits in spite of the impacts. If the country would loudly and forcefully demand National Health Insurance this discussion about mammograms would not be a topic of discussion.

You can bet that elected officials wives will receive mammograms on demand have no fear.

Shouldn't taxpayers have the choice of National health Insurance For All? Absolutely!

National Health Insurance would cover every person for all necessary medical care including:
*long term care such that cancer demands
*prescription drugs
* hospital
* surgical
* outpatient services
* primary and preventive care
* emergency services
* dental
* mental health
* home health
* physical therapy
* rehabilitation (including for substance abuse)
* vision care
* hearing services including hearing aids
* chiropractic
* durable medical equipment
* palliative care
* long term care.

A family of four making the median income of $56,200 would pay about $2,700 annually for all health care costs with National Health Insurance.

National Health Insurance ends deductibles and co-payments.
24 November 2009
at 8:19 a.m.

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merrill (Anonymous) says…

The Health Insurance debate brings up many viewpoints. The mammogram debate should be left to the doctor and the clients choice. I am sure it should not be left up to politicians on both sides of the aisle who hold millions in share holdings( according to many news sources).

While WE taxpayers provide “Mercedes Benz” health insurance coverage for the elected officials on both sides of the aisle it is stunning to realize how many out here in public taxpayer land are against saving thousands of dollars a year on medical insurance.
http://www.healthcare-now.org/hr-676/

All legislators protecting the most expensive medical insurance in the world are increasing our cost of living.

National Health Insurance and ONLY National Health Insurance will reduce the cost of medical insurance by billions through eliminating the reckless spending habits of the medical insurance industry.

National Health Insurance eliminates:
• industry bureaucracy which increases YOUR cost
• industry profits that increase YOUR cost
• industry high corporate salaries that increase YOUR cost
• industry advertising that increases YOUR cost
* industry over charges that increase YOUR cost
• industry sales commissions that increase YOUR cost
• industry Shareholders which are the primary clients of for-profit insurance companies that which increase YOUR cost
• industry Special interest campaign dollars that increase YOUR cost
• industry Golden parachutes that increase YOUR cost

* Eliminates Politicians as shareholders:
http://www.pbs.org/moyers/journal/071…
http://www.pbs.org/moyers/journal/blo…

* Eliminates Insurers Wrongfully Charging Consumers Billions
http://www.washingtonpost.com/wp-dyn/…

This is something to never forget. It is the private medical insurance industry that cancels YOUR medical insurance AFTER taking your money for years.

Smart National Insurance for All will not only improve our quality of life but also our wallets.

Yes we would have more expendable cash for birthdays,Christmas, vacations and investments.
24 November 2009
at 8:46 a.m.

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Cappy (Anonymous) says…

Remember, too, that a mammogram is an x-ray procedure. One doctor I heard said that each mammogram a woman has adds 2% probability of causing cancer to ones base cancer rate. (i.e. if your base rate of getting cancer is, let's say, 10% then after your first mammogram it is 10.02%. It's cumulative and the earlier you start the more you accumulate.) You have to factor all the pros and all the cons.
24 November 2009
at 9:07 a.m.

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snap_pop_no_crackle (Anonymous) says…

What's the difference between HR 676 and a peach pit lodged in a mandrill's bowels?
The peach pit has a chance of being passed.

24 November 2009
at 9:07 a.m.

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merrill (Anonymous) says…

Politics News & Analysis:

Stock-owning members of Congress warned of ethical breaches

http://www.washingtonpost.com/wp-dyn/…
24 November 2009
at 9:28 a.m.

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75x55 (Anonymous) says…

Cut-n-paste - when are profits 'acceptable' and when are they 'excessive'?

You seem to have a real problem with the idea of 'profit', when that is the resource that allows businesses the ability to perform a particular function. Without profit, there is no ability, much less incentive, to perform needed activities.

So, when does 'profit' become evil ?

Really, if you are going to rail and demonize the driving force of human activity, please be able to provide a succinct and quantifiable basis for determining when profit is 'evil' and when it is 'acceptable'.
24 November 2009
at 9:53 a.m.

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arizonajh (Anonymous) says…

Snap,
A better question would be where would a “mandrill”, an inhabitant of the central west coast of Africa, get a peach that does not grow within a thousand miles of that area? Also, why are you so infatuated by its bowel movements so much that you mention them whenever anything relating to healthcare is written? Is there something about that blue and red rear end that fasinates you into watching and caring what comes out of it?
24 November 2009
at 10:09 a.m.

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Cappy (Anonymous) says…

Or how did that peach pit actually get in there, I wonder. Hmmm?
24 November 2009
at 10:18 a.m.

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ralphralph (Anonymous) says…

The statement: “having pre-50 mammograms ends up doing more damage to women than not having them” strikes me as a real contortion. I have had a number of friends who have been diagnosed and saved from cancer by screening, and a few who were lost for the lack of it. Those who were screened and found their cancer early would most certainly disagree that it did them more harm than good. Would those who were inconvenienced by further testing or anxiety truly sacrifice the lives of the others to avoid that inconvenience? Wow. I hope not.
This is all about rationing.
24 November 2009
at 10:47 a.m.

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barrypenders (Anonymous) says…

The humans that do not contribute to the greater good of the planet, need to be allowed to succumb. Humanely, for the emotionally sensitive folk.

Stimulus and Posercare lives

Darwin bless you all
24 November 2009
at 11:05 a.m.

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bad_dog (Anonymous) says…

arizonajh, you have to understand that snap likes to use these catchy *jokes*, one-liners and euphemisms to underscore his frustration with the current administration. He likes to work this one in betweeen other proven winners like “Dear Leader”, “ACORN this or that”, “Axelrod's puppet”, etc.

Although Snap's infatuation with the mandrill's digestive conundrum is a bit puzzling, he's only posted the question 11 times between 10/25/09 and today. Despite his numerous inquiries, Snap offers no suggestions to resolve the poor mandrill's plight.

Perhaps snap should just relax and have a popsicle. Peach flavored anyone?
24 November 2009
at 11:28 a.m.

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kmat (Anonymous) says…

First - this isn't big govt saying you shouldn't get mammograms. Can you get off your really old and irritating B.S. about govt rationing STRS. This is a panel of private health care professionals.

http://www.ahrq.gov/clinic/uspstfab.htm

And, you think the piece of cr*p insurance companies we currently are stuck with aren't rationing these sevices? Maybe if you had to get these tests done every year, you might have a clue.

I'm not 40 yet and have already lost my sister to breast cancer and my mother survived it. Every oncologist says that I am super high risk and must have one mammogram every year until 40, then possibly twice a year after that. I had to fight to get insurance to cover it. They still question it every year, even though I have letters on file with the insurance company stating that I must have this procedure done. The private insurance companies are who ration services, especially to those of us that really do need them.

The person that wrote this article is a whiner. If she had to be firmly reminded by doctors to get something so easy and basic as a mammogram, then she's a lazy whiner. It takes a couple of minutes and isn't that big of a deal. I'd rather have that done than have to sit in traffic.

Radiation isn't good for our bodies. If you aren't in a high risk category, then why up your chances of developing problems from getting unnecessary radiation?

And, the place I go to in KC is only $149 for a mammogram. If you're overly concerned and want a mammogram that your insurance won't pay for, it's not that expensive of a test to have done. I know a lot of women that will drop more money for a pair of shoes.

24 November 2009
at 12:19 p.m.

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remember_username (Anonymous) says…

Hey, I appreciated Snaps comment as I had no idea what a mandrill was - now I do. What an interesting looking creature. Since several exist in zoos throughout the world it's quite possible they could be fed peaches. Anyway, what were we posting about?
24 November 2009
at 12:41 p.m.

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gccs14r (Anonymous) says…

My understanding is that they're recommending pushing regular screening out to age 50 only for women with no history of breast cancer in their families. This is not a blanket recommendation for all women.