U.S. Preventive Services Task Force Guidlines

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7starmantis

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"The fight against breast cancer faces a new challenge as the U.S. Preventive Services Task Force (USPSTF) announced Monday their recommendation against routine screening mammography in women below the age of 50. The report also suggests there is little benefit to mammography screenings for women above the age of 75."

"This report contradicts decades-long recommendations by breast cancer experts that women should begin routine mammography screening at age 40. In response to the report, the American Cancer Society, one of the world's foremost leaders in cancer research and studies, released a statement saying, "With its new recommendations, the Task Force is essentially telling women that mammography at age 40 to 49 save lives; just not enough of them."

FRISCO, TX -- 11/18/09

What do you guys think about this whole ordeal? Looks like political pundits are quickly jumping aboard to spin their own version, but it seems a little odd to me. Are we looking at an early trial for budgeting healthcare in the new "public option" bills? In my opinion this is a terrible start for constraining healthcare costs. Is this what we have to look forward to when helathcare is under governmental budget constraints?

Opinions, ideas?

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"The fight against breast cancer faces a new challenge as the U.S. Preventive Services Task Force (USPSTF) announced Monday their recommendation against routine screening mammography in women below the age of 50. The report also suggests there is little benefit to mammography screenings for women above the age of 75."

"This report contradicts decades-long recommendations by breast cancer experts that women should begin routine mammography screening at age 40. In response to the report, the American Cancer Society, one of the world's foremost leaders in cancer research and studies, released a statement saying, "With its new recommendations, the Task Force is essentially telling women that mammography at age 40 to 49 save lives; just not enough of them."

FRISCO, TX -- 11/18/09

What do you guys think about this whole ordeal? Looks like political pundits are quickly jumping aboard to spin their own version, but it seems a little odd to me. Are we looking at an early trial for budgeting healthcare in the new "public option" bills? In my opinion this is a terrible start for constraining healthcare costs. Is this what we have to look forward to when helathcare is under governmental budget constraints?

Opinions, ideas?
glenn-beck.jpg
 
Anything to add that, I dont know, contains facts or logical arguments?
Or do you believe contrary to the American Cancer Society as well?
 
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No one is saying it is federal policy (yet) but from your article:

Said Ms. Wasserman Schultz: “As a result, because of the confusion, because you have the American Cancer Society and the Komen Foundation adamantly against these recommendations, the task force making the recommendations, the insurance companies making decisions based on those recommendations, you are going to end up causing fewer and fewer women, who are 40 to 49, to be able to get to early screening and mammograms, and we know that that will cause more deaths, which is the opposite of what we’ve had happen over the last 20 years. Since we’ve had routine screening for women over 40, the death rate has come down.”

Thats acceptable to you?
 
lol seriously? I guess you shut me up! :rolleyes:

Again, a near vacuum of logical arguments and facts or even sources accompanies most of your posts. Either post something that contributes to the thread (aside from sad appeals to emotion) or just stfu.

I assume you agree with the change in guidelines?
 
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"The fight against breast cancer faces a new challenge as the U.S. Preventive Services Task Force (USPSTF) announced Monday their recommendation against routine screening mammography in women below the age of 50. The report also suggests there is little benefit to mammography screenings for women above the age of 75."

"This report contradicts decades-long recommendations by breast cancer experts that women should begin routine mammography screening at age 40. In response to the report, the American Cancer Society, one of the world's foremost leaders in cancer research and studies, released a statement saying, "With its new recommendations, the Task Force is essentially telling women that mammography at age 40 to 49 save lives; just not enough of them."

FRISCO, TX -- 11/18/09

What do you guys think about this whole ordeal? Looks like political pundits are quickly jumping aboard to spin their own version, but it seems a little odd to me. Are we looking at an early trial for budgeting healthcare in the new "public option" bills? In my opinion this is a terrible start for constraining healthcare costs. Is this what we have to look forward to when helathcare is under governmental budget constraints?

Opinions, ideas?

At the very least, the American Cancer Society explained its concerns with rational reasoning. By and large, the uproar over these new guidelines is fairly ludicrous and short on actual facts.

First of all, these recommendations are for asymptomatic women without risk factors, so to say otherwise is plain wrong. Second of all, whether you like them or not, it is nevertheless clear that these new guidelines are based on sound science, and a sober evaluation thereof. The subjective part is at what point the harm of overdiagnosis, overtreatment, and cost outweigh further improvements in early detection. The literature seem to indicate that commencing screening at 40 only results in a very modest reduction in mortality vs. starting at 50; while ANY reduction in mortality is a good thing, to be sure, it is important to remember that there IS a point at which small gains no longer justify accepting the increased risk.

After all, why not just start screening yearly at puberty? And not just for women! Screen everybody. Because the arguments I've been hearing against the new screening recommendations essentially boil down to "If it saves just ONE more life, it's worth it". This sort of thinking is ridiculous on its face, especially when you consider that for every life saved, there is a nonzero amount of harm caused to many more. As you begin screening younger and younger, the ratio of lives saved to harm caused starts dropping dramatically.

The science isn't in question. What is in question is where we as a society draw that line between acceptable and unacceptable harm.

One of my favorite bloggers, Orac, concluded his post on the subject thus:

Orac said:
n the meatime, screening asymptomatic people for disease always comes down to a balance of risks and benefits, as well as values. In the case of breast cancer, starting at 40 appears only to modestly increase the number of lives saved but at a high cost, while screening yearly only increases the detection of breast cancer marginally compared to screening every other year, also at a high cost in terms of more biopsies and more overdiagnosis. Whether the cost is worth it or not comes down to two levels. First and foremost, what matters is the woman being screened, what she values, and what her tolerance is for paying the price of screening at an earlier age, such as a high risk for overdiagnosis, excessive biopsies, and overtreatment in order to detect cancer earlier and a relatively low probability of avoiding death from breast cancer because of screening. Then there's the policy level, where we as a society have to decide what tradeoffs we're willing to make to save a life that otherwise would have been lost to breast cancer. Although screening programs and recommendations should be based on the best science we currently have, deciding upon the actual cutoffs of who is and is not screened and how often unavoidably involves value judgments. Such decisions always will.
 
lol seriously? I guess you shut me up! :rolleyes:

Again, a near vacuum of logical arguments and facts or even sources accompanies most of your post
s. Either post something that contributes to the thread (aside from sad appeals to emotion) or just stfu.

I assume you agree with the change in guidelines?
oh? you've compiled stats on my near 2k posts the most of which are probably in the MCAT forum?
 
No one is saying it is federal policy (yet) but from your article:



Thats acceptable to you?

The article also says "Indeed, I would be very surprised if any private insurance company changed its mammography coverage decisions as a result of this action."

I'm not saying that I love the recommendation but if you have a history of cancer you're going to still get earlier screenings and there's always self examination
 
First of all, these recommendations are for asymptomatic women without risk factors, so to say otherwise is plain wrong. Second of all, whether you like them or not, it is nevertheless clear that these new guidelines are based on sound science, and a sober evaluation thereof. The subjective part is at what point the harm of overdiagnosis, overtreatment, and cost outweigh further improvements in early detection. The literature seem to indicate that commencing screening at 40 only results in a very modest reduction in mortality vs. starting at 50; while ANY reduction in mortality is a good thing, to be sure, it is important to remember that there IS a point at which small gains no longer justify accepting the increased risk.
Who are you referencing? No one said anything about it being anything other than "asymptomatic" women. We are talking about routine screenings, thought that was clear. Actually, its not clear that the study was based on "sound science". Would you care to offer some facts or sources for that statement? The study itself has been under fire. I guess the American Cancer Society et al simply dont use "sound science". :rolleyes:

The "costs outweigh the gains" argument is moot. We are talking about routine screenings that have the benefit of that "sound science" behind them and actually save lives.

After all, why not just start screening yearly at puberty? And not just for women! Screen everybody. Because the arguments I've been hearing against the new screening recommendations essentially boil down to "If it saves just ONE more life, it's worth it". This sort of thinking is ridiculous on its face, especially when you consider that for every life saved, there is a nonzero amount of harm caused to many more. As you begin screening younger and younger, the ratio of lives saved to harm caused starts dropping dramatically.
Did you actual read the article or the study? Your response is nonsensical. We aren't talking about screening younger people, its talking about increasing the age. The guideline has been 40 for a long time. Your statement is short on fact and heavy on emotional charge. Saving "one" life is worth it, but we aren't talking about saving one life but many. I guess 15% is insignificant to you?

The science isn't in question. What is in question is where we as a society draw that line between acceptable and unacceptable harm.
Thats a good point, do you have any sources to show how this new guideline would fall into line with the harm ratio?

oh? you've compiled stats on my near 2k posts the most of which are probably in the MCAT forum?

Do you actually have anything to contribute to this thread?
 
Orac said:
deciding upon the actual cutoffs of who is and is not screened and how often unavoidably involves value judgments. Such decisions always will.

This is exactly my point. Bottom line on this is who do we think should make those value judgments. Are these better made by the patient and her physician or the insurance company/government (if in the public option)?
 
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Did you actual read the article or the study? Your response is nonsensical. We aren't talking about screening younger people, its talking about increasing the age. The guideline has been 40 for a long time.

I believe what redsquare is saying is that the same logic that starts screening at 40 could be used to start screening at 35, or 30, or 25, etc. So where do you draw the line?

Diagnosing breast cancer is not a benign process, so to speak. Yearly does of radiation kill people. Anesthesia kills people. Overtreatment kills people.

Ah, this gonna be a fun one to watch.
 
Bottom line on this is who do we think should make those value judgments. Are these better made by the patient and her physician or the insurance company/government (if in the public option)?

Let's ask the U.S. Preventive Services Task Force Guidelines:

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.
 
I believe what redsquare is saying is that the same logic that starts screening at 40 could be used to start screening at 35, or 30, or 25, etc. So where do you draw the line?
Thats just not accurate. The same logic could not be used for screening 25 year olds.

Diagnosing breast cancer is not a benign process, so to speak. Yearly does of radiation kill people. Anesthesia kills people. Overtreatment kills people.
You can't be serious. This number is so immensely small (if anything at all) that its basically nothing. This is a poor argument for not screening people from 40-49 years of age.
 
you sound like you don't really want anyone else's thoughts. You just want to rage and make sure everyone knows your opinion is the one that matters.
 
Thats just not accurate. The same logic could not be used for screening 25 year olds.


You can't be serious. This number is so immensely small (if anything at all) that its basically nothing. This is a poor argument for not screening people from 40-49 years of age.
Actually, redsquare's argument can be used to support screening 25 year olds. Even you yourself said "saving one life is worth it." Sure, you're unlikely to get breast cancer in your 20s but it doesn't mean it doesn't happen. And using the argument of "saving even one life is worth it," it can be argued that screening 25 year olds is worth it.

you sound like you don't really want anyone else's thoughts. You just want to rage and make sure everyone knows your opinion is the one that matters.

Yea, I'm sensing this as well.
 
Sarah Palin is right about "Death Panels" and this is an obvious start. This new guideline is absolutely shameful.
 
You can't be serious. This number is so immensely small (if anything at all) that its basically nothing. This is a poor argument for not screening people from 40-49 years of age.

Well, 7star, other than the fact that "That's just what we've been doing since 2002, and it would be a shame to change it", what is a good argument for screening commencing at 40? I mean, whether you like it or not, the logical conclusion of your position is that everybody should be screened, regardless of age. Young women get breast cancer, and so do men. The only way to make absolutely sure is to screen everyone.

Obviously, we don't do that, and there is a reason. It's the same reason I gave above, namely that as a culture there is a certain point after which we are not prepared to accept increased risk for marginal benefit. These recommendations use more current evidence in order to come to the conclusion that the benefits of earlier screening are uncertain and carry risk of overdiagnosis, overtreatment, and the significant harm of biopsies and emotional distress (which, if you're a woman worried that you may have breast cancer, is significant, I can assure you).

If you'd like "evidence", as you keep requesting, that this is based on sound science, why don't you do yourself a favor and actually read the recommendations. You'll be looking for the little section titled "References".

I fail to see why it's so hard for you to understand. This isn't "health-care rationing" in the sense that you seem to be insinuating. This is evidence-based medicine, of which until recently you seemed to be a fan. Am I arguing that we should abandon all previous practices? Nope. These are just recommendations, and until adopted in a larger sense, I'm all for continuing to follow the standard of care.
 
With my mother being the first case of breast cancer in our family history, asymptomatic, diagnosed by a routine screening mammogram at 48 with absolutely no history or symptoms.... and myself, diagnosed with cancer in my 20's with no pre-existing conditions, negative for the brach genes, no symptoms except that I found a lump during a routine self examination.... I think it's a sad day when my life is considered a statistical insignificance.

Not to mention all of the young women that I've had the pleasure of meeting at the cancer treatment centers who share similar stories of finding cancer during routine screenings and/or palpating lumps.

The recommendations are absurd!
 
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Let me get this right. One governmental agency decides to change guidlines and everyone just blindly starts arguing for them? Ignoring the multitude of groups, including the ACA and Komen (among others)? Obviously they are simply wrong, outdated, and interested in killing women if they disagree with the "government" :rolleyes:

As far as "rationing" goes. I didn't suggest it was but could be in the future. So all those saying that's absurd, your saying that you honestly believe that a government task force comes out with new guidlines but a government run health insurance program is going to ignore it and just keep paying for those younger women's screenings?
 
Not to mention all of the young women that I've had the pleasure of meeting at the cancer treatment centers who share similar stories of finding cancer during routine screenings and/or palpating lumps.

If you don't mind me asking, what was your diagnosis?
 
Let me get this right. One governmental agency decides to change guidlines and everyone just blindly starts arguing for them?

There has to be some balance for the people who will just blindly start arguing against them. Yin and yang, and all that.
 
Let me get this right. One governmental agency decides to change guidlines and everyone just blindly starts arguing for them? Ignoring the multitude of groups, including the ACA and Komen (among others)? Obviously they are simply wrong, outdated, and interested in killing women if they disagree with the "government" :rolleyes:

Now, now, 7star. Don't put words in my mouth. I am neither "blindly... arguing for them", nor "ignoring the multitude of groups". I don't consider them "simply wrong, outdated, and interested in killing women if they disagree with the 'government'". You're setting up a straw man and then giving yourself a pat on the back when you knock it down.

I merely said the new guideline recommendations were based on an evaluation of the evidence, but in the end are admittedly a subjective judgment based upon weighing risk/benefit. Whether you agree with them or not, it's not a question of science, but rather a matter of deciding where the appropriate balance is for you.

As I have said before, this "even 1 life is worth it" nonsense could be used to justify screening everyone, regardless of age. Obviously we draw the line somewhere. Why do we draw it where we do currently? What makes 40 acceptable, but 30 not, for instance? We'd likely save a few more lives in so doing, yet we don't hear people arguing for this, yourself included. Why not? Because there is the recognition that at a given point, the added risk is unacceptable in the face of marginal benefit.

As far as "rationing" goes. I didn't suggest it was but could be in the future. So all those saying that's absurd, your saying that you honestly believe that a government task force comes out with new guidlines but a government run health insurance program is going to ignore it and just keep paying for those younger women's screenings?

At this point, it's mere speculation, so I don't really see any point in arguing about it. I'm not worried, personally. But then, I don't view my government as a bunch of socialist Nazis (an oxymoron if I ever heard one) intent on employing the "Final Solution" through health care rationing.

cher25 said:
With my mother being the first case of breast cancer in our family history, asymptomatic, diagnosed by a routine screening mammogram at 48 with absolutely no history or symptoms.... and myself, diagnosed with cancer in my 20's with no pre-existing conditions, negative for the brach genes, no symptoms except that I found a lump during a routine self examination.... I think it's a sad day when my life is considered a statistical insignificance.

Cher, while I sympathize, and admit that I can never understand the circumstances you describe, I must nevertheless counter that it's a bit of a leap to conclude that your "life is considered a statistical insignificance". That's not what's being said at all. It's a recognition that at some point, the risks of overdiagnosis, overtreatment, and biopsy outweigh the benefit of screening more women.
 
Cher, while I sympathize, and admit that I can never understand the circumstances you describe, I must nevertheless counter that it's a bit of a leap to conclude that your "life is considered a statistical insignificance". That's not what's being said at all. It's a recognition that at some point, the risks of overdiagnosis, overtreatment, and biopsy outweigh the benefit of screening more women.

agreed.
And as a counter to Cher's story of having cancer so young (which was not found by a mammogram, but by self exam in the first place), AOL has this big story on their homepage last night about a woman having a mammogram in her 30s and spending 3 months thinking she had cancer when really it was one of those false positives that sometimes happen with mammograms. She felt all the same emotions as Cher probably did but then found out 3 months later that "oops we made a mistake". That freaking sucks too.

It really comes down to a balance of not wanting to over treat and freak out people who get false positives and trying to save as many women as possible by early detection.

I'm not saying I love them pushing mammograms back 10years but it is a recommendation based on evidence that should be studied and considered further. We shouldn't automatically go OMG WTF NO YOU'RE KILLING WOMEN any more than we should blinding jump in and cut women off from mammorgrams and discourage self exams. Can't there be a happy medium?
 
This reminds me of the reactions many people in America have against the term "rationing". Any productive discussion of health related issues is clouded by politics. Then again, if insurance was structured differently, and patients controlled a larger share of their health care dollars instead of third party payers, this knee jerk reaction would be much more subdued.

Either way, a decision to receive early screening will still be made between a doctor and a patient. Broad guidelines are just that--broad guidelines. Plus, no one is preventing patients from purchasing mammograms out of pocket if they feel they will receive a benefit from such screening. Insurance may not cover a certain service, but you can always pay for it yourself and choose not to buy insurance based upon the level of benefits they offer and your needs as a patient. Unfortunately, this may not be the case for much longer.
 
Now, now, 7star. Don't put words in my mouth. I am neither "blindly... arguing for them", nor "ignoring the multitude of groups". I don't consider them "simply wrong, outdated, and interested in killing women if they disagree with the 'government'". You're setting up a straw man and then giving yourself a pat on the back when you knock it down.

I merely said the new guideline recommendations were based on an evaluation of the evidence, but in the end are admittedly a subjective judgment based upon weighing risk/benefit. Whether you agree with them or not, it's not a question of science, but rather a matter of deciding where the appropriate balance is for you.

As I have said before, this "even 1 life is worth it" nonsense could be used to justify screening everyone, regardless of age. Obviously we draw the line somewhere. Why do we draw it where we do currently? What makes 40 acceptable, but 30 not, for instance? We'd likely save a few more lives in so doing, yet we don't hear people arguing for this, yourself included. Why not? Because there is the recognition that at a given point, the added risk is unacceptable in the face of marginal benefit.



At this point, it's mere speculation, so I don't really see any point in arguing about it. I'm not worried, personally. But then, I don't view my government as a bunch of socialist Nazis (an oxymoron if I ever heard one) intent on employing the "Final Solution" through health care rationing.



Cher, while I sympathize, and admit that I can never understand the circumstances you describe, I must nevertheless counter that it's a bit of a leap to conclude that your "life is considered a statistical insignificance". That's not what's being said at all. It's a recognition that at some point, the risks of overdiagnosis, overtreatment, and biopsy outweigh the benefit of screening more women.


:thumbup:

It's sad that the issue of breast cancer has being moved from a medical issue to a political issue. Politicians use their support of breast cancer as a seal of their "pro-women" cred.

1 in 1900 women 40-49 is saved through the current guideline of routine mammogram screening. However, 470 false alarms in every 1,000. This means needless biopsies and exposure to radiation which also increase one's risk.

I'm not surprised by ACR and Sloan-Kettering stance. I don't think they are looking at this objectively.

Edit: No one is arguing that women in their 40s shouldn't get a mammogram screen but the benefits of routine screening for this age group is what's been debated.
 
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I personally doubt the recommendations will change much of anything except blood pressure. However, I think everyone should take the time to read this page from the California Breast Cancer Research Program website entitled "Changes in Breast Cancer Mortality Rates."

This debate falls prey to a false paradigm: cancer caught earlier = better while cancer caught later = worse. While true in the most general sense, it doesn't always work out this way, and breast cancer is a prime example.

But I'll let the page speak for itself.

The decline in mortality has largely been attributed to broader screening leading to earlier stage at diagnosis, so it is understandable that access to and utilization of screening and treatment has been hypothesized as the major reason for these disparities in mortality. However, as we will see, the data on changes in incidence and mortality suggest that changes in treatment, not early detection, may play a more important role in explaining the recent decline in mortality.

Clearly, Dr. Kramer was suggesting that early detection had failed to live up to its promise. “If screening worked perfectly,” the article continues, “every cancer found early would correspond to one fewer cancer found later. That, he (Kramer) said, did not happen. Mammography, instead, has resulted in a huge new population of women with early stage cancer but without a corresponding decline in the numbers of women with advanced cancer.” The modest size of the reductions in later stage cancers and the unchanged status of metastatic disease are troubling. It appears that the early-detection approach to reducing cancer mortality fails to take into account the reality that some tumors are so aggressive that even the earliest detection will fail to eradicate them, while others are so indolent that it seems to make little difference if they are found before they become palpable. The burden of advanced breast cancer shows no real sign of abating, and is likely to continue and even increase as treatments prolong life.

So there you have it, the tip of a very large and messy battle that has been playing out for the last 25 years.
 
It's hard for me to wrap my head around the idea of cost vs. benefit when it comes to patient's lives... but I wanted to bring attention to this statement in the USPSTF recommendation.

Clinical Breast Examination

Potential Preventable Burden. The evidence for CBE, although indirect, suggests that CBE may detect a substantial proportion of cases of cancer if it is the only screening test available. In parts of the world where mammography is infeasible or unavailable (such as India), CBE is being investigated in this way.

Potential Harms. The potential harms of CBE are thought to be small but include false-positive test results, which lead to anxiety and breast cancer worry, as well as repeated visits and unwarranted imaging and biopsies.

Costs. The principal cost of CBE is the opportunity cost incurred by clinicians in the patient encounter.

Current Practice. Surveys suggest (1) that the CBE technique used in the United States currently lacks a standard approach and reporting standards. Clinicians who are committed to spending the time on CBE would benefit their patients by considering the evidence in favor of a structured, standardized examination (2).

I realize that the evidence is lacking, but what I understand is that a simple standardization and focus on clinical breast examination by a trained physician would be a great way to cut costs and reach as many people as possible. Perhaps advances in technology are not always best for patients. It will be interesting to see the results of the studies in India.
 
Perhaps advances in technology are not always best for patients. It will be interesting to see the results of the studies in India.

One of my favorite medical acronyms is "VOMIT", which stands for "Victim of Medical Imaging Technology". There is a tendency to believe that any technological advance must be a uniform good, without considering that there may be instances where it is not necessarily helpful.
 
when MRI's become more prominent and affordable, this will be a think of the past.
 
I merely said the new guideline recommendations were based on an evaluation of the evidence, but in the end are admittedly a subjective judgment based upon weighing risk/benefit. Whether you agree with them or not, it's not a question of science, but rather a matter of deciding where the appropriate balance is for you.
Precisely. That is my point, albeit we disagree on the stature of the "evidence" it is based on. This however becomes an issue when your asking for a screening as a member of a "public option" that has decided not to pay for these "unnecessary" screenings. Thats one of my biggest issues with these so called public options, there is little "option" in them. They take power and decision away from the patient at a time we should be empowering and educating the patient on their decisions.

As I have said before, this "even 1 life is worth it" nonsense could be used to justify screening everyone, regardless of age. Obviously we draw the line somewhere. Why do we draw it where we do currently? What makes 40 acceptable, but 30 not, for instance? We'd likely save a few more lives in so doing, yet we don't hear people arguing for this, yourself included. Why not? Because there is the recognition that at a given point, the added risk is unacceptable in the face of marginal benefit.
Except we are not talking about 1 life, but many. Speaking of setting up strawmen, we aren't discussing the "one life" issue, that is moot. We have valid evidence and science to back the routine screenings at 40. The problem comes when we start just defaulting to the government for our decisions. We take these knee jerk reactions and say the government must be right. We have seen that proven false even just in the governments websites. Lets look at the real evidence and why so many groups suggest starting at 40. I have a problem with the government coming in to tell non-partisan (non-political) groups how to make suggestions. The risk of corruption (especially dealing with the government) is huge doing it this way. Its about who we trust to make these types of suggestions.

At this point, it's mere speculation, so I don't really see any point in arguing about it. I'm not worried, personally. But then, I don't view my government as a bunch of socialist Nazis (an oxymoron if I ever heard one) intent on employing the "Final Solution" through health care rationing.
Haha, now now Red, lets not go putting words in my mouth either.

The "speculation fallacy" is the easiest way to avoid the facts. I mean at some level its all speculation. We have no full bill yet so really no one should even be discussing healthcare reform at all! :rolleyes:

Cher, while I sympathize, and admit that I can never understand the circumstances you describe, I must nevertheless counter that it's a bit of a leap to conclude that your "life is considered a statistical insignificance". That's not what's being said at all. It's a recognition that at some point, the risks of overdiagnosis, overtreatment, and biopsy outweigh the benefit of screening more women.

The American Cancer Society disagrees with you.
Dr. Len Lichtenfeld (ACS) said:
The review of the various clinical trials as reported by OHSU showed that mammography reduced deaths from breast cancer by about 15% in women ages 40-49. They also found that 1904 (range 929-6378) women had to be screened over 10 years to save one life. For women ages 50-59 years, the reduction in deaths was about the same (14%). The number that needed to be screened was 1339 (range 322-7455). In women ages 60-69, the reduction in deaths was 32%, and the number who needed to be screened over 10 years was 377.

What this means is that mammograms are indeed successful in reducing deaths from breast cancer in all age groups, especially women between 60 and 69 years old. But since the actual incidence of breast cancer is less in women ages 40-49, the absolute/actual numbers of lives saved is also less. So you have to screen more women to get the same benefit.

Stated another way, the Task Force agrees that mammography reduces deaths in women ages 40-49. It just doesn’t save enough lives, in their opinion.

Dr. Len Lichtenfeld (ACS) An interesting read if one were so inclined. A few points:
What about those risks and harms of getting a mammogram? Here is what did the OHSU investigators have to say:

No significant damage was seen from the radiation associated with mammograms.

Mammograms can be painful, but “few (women) would consider this a deterrent from future screening.”

There was no consistent effect on most women with regards to the anxiety associated with mammograms, but it was an issue for some women.

“False positive” mammograms—where the screening mammogram suggests there may be a cancer, but eventually none is found—are an issue, with more of them in younger women compared to older women. But false positive mammograms that lead to an actual biopsy are less common in younger women than in older women, which means that younger women may need more extra mammograms or ultrasounds to take a look at a suspicious area but don’t actually have to have a biopsy done when compared to older women where the opposite is true. (In more precise terms, according to the paper, in women ages 40-49, for every case of invasive breast cancer that is diagnosed 556 women have a mammogram, 47 have additional images, and 5 have biopsies.)

Overdiagnosis was a difficult issue to address, because there really is no direct way of determining which breast cancers we treat are cancers that might lead to a woman’s death as compared to breast cancers we treat that would never cause a problem. They concluded that overdiagnosis rates in various studies ranged from 1% to 30%, with most falling between 1% to 10%.

As the Oregon researchers point out based on this analysis, “These estimates are difficult to apply because, for individual women, it is not known which types of cancer will progress, how quickly cancer will advance and expected lifetimes.”

The largest burden of overdiagnosis probably occurs in the population of older women, where you can diagnose and treat a breast cancer but woman wouldn’t have a problem with the breast cancer because she had another serious disease and died from something other than breast cancer. If that is where the bulk of the problem lies, then that is a different situation than having overdiagnosis in a young woman, where it could impact the quality of her life for many more years.
Let’s now focus on the other research report which was based on a very sophisticated computer model designed and supported by the National Cancer Institute. The purpose of this model was to try and determine at what age screening mammography should begin, when it should end, and how often it should be done.

The model actually looked at 20 different age/frequency “scenarios.” Six different institutions around the country that participate in this project looked at each of these scenarios and came up with their own estimates of how the different combinations of age and frequency impacted the benefits of getting a screening mammogram.

I suspect to no one’s surprise, each of these six complex computer models came up with different answers for the same questions.

For example, in one model, if you screened only women from 50-74 and did it every two years, you reduced breast cancer deaths by about 28%. If you did it every year from age 40 to 84, you reduced mortality by about 54%. In another model, the same numbers were about 22% and 38%. In the first study, doing mammograms every other year for more years made a big difference. In the second study, it still made a difference, but not quite as much. And there were still other studies where it made little or no difference.
The question, however, is whether or not the models are sufficiently accurate to tell us with reasonable certainty what would happen under a particular situation. It is one thing to try to predict the future or support a theory. It is quite a different thing, in my opinion, when you take computer models and make public policy that affects millions of women with respect to a life threatening disease. Even though the models may be very well designed, there are always questions about how well they truly reflect or predict “real life.”
And then there is health care reform, where the influence of the Task Force may be considerable under the various legislative proposals currently wending their way through Congress.
Wow, where is bleargh's Glen Beck picture? We need it for the ACS.
 
Precisely. That is my point, albeit we disagree on the stature of the "evidence" it is based on. This however becomes an issue when your asking for a screening as a member of a "public option" that has decided not to pay for these "unnecessary" screenings. Thats one of my biggest issues with these so called public options, there is little "option" in them. They take power and decision away from the patient at a time we should be empowering and educating the patient on their decisions.


Except we are not talking about 1 life, but many. Speaking of setting up strawmen, we aren't discussing the "one life" issue, that is moot. We have valid evidence and science to back the routine screenings at 40. The problem comes when we start just defaulting to the government for our decisions. We take these knee jerk reactions and say the government must be right. We have seen that proven false even just in the governments websites. Lets look at the real evidence and why so many groups suggest starting at 40. I have a problem with the government coming in to tell non-partisan (non-political) groups how to make suggestions. The risk of corruption (especially dealing with the government) is huge doing it this way. Its about who we trust to make these types of suggestions.


Haha, now now Red, lets not go putting words in my mouth either.

The "speculation fallacy" is the easiest way to avoid the facts. I mean at some level its all speculation. We have no full bill yet so really no one should even be discussing healthcare reform at all! :rolleyes:



The American Cancer Society disagrees with you.


Dr. Len Lichtenfeld (ACS) An interesting read if one were so inclined. A few points:




Wow, where is bleargh's Glen Beck picture? We need it for the ACS.

you are seriously glenn beck jr. not everything is a vast left wing conspiracy. get over yourself.
 
you are seriously glenn beck jr. not everything is a vast left wing conspiracy. get over yourself.

Once again you put words into my mouth and personally attack me rather than just present any factual or logical information to prove me wrong.

When you can formulate an argument we'll talk.
 
I think it is logical and and cost effective on multiple levels. It strikes a chord with the women who were diagnosed before age 50, but just like any disease there is going to be a risk of it happening at every age. These women that are outraged are obviously not the ones that got subjected to the deluge of biopsies, fear and (trace amounts) of radiation for no reason. They are also not the ones reading mammograms and realizing that it is REALLY tough to distinguish, particularly in dense breast tissue. I'd be more for genetic testing to see if there is a predisposition and adjust the stuff accordingly...or just a better screening tool.

My mom actually had breast cancer in her 40s, so I'm going against my own experiences.
 
I think it is logical and and cost effective on multiple levels. It strikes a chord with the women who were diagnosed before age 50, but just like any disease there is going to be a risk of it happening at every age. These women that are outraged are obviously not the ones that got subjected to the deluge of biopsies, fear and (trace amounts) of radiation for no reason. They are also not the ones reading mammograms and realizing that it is REALLY tough to distinguish, particularly in dense breast tissue. I'd be more for genetic testing to see if there is a predisposition and adjust the stuff accordingly...or just a better screening tool.

My mom actually had breast cancer in her 40s, so I'm going against my own experiences.

While I agree with you to a point, I think your missing the real issue. Many women who have undergone the "biopsies, fear, and (trace amounts) of radiation" are happy with the results. You state that it was for no reason, but thats not really true, it was with great reason, just turned out to be false.
Dr. Len Lichtenfeld said:
But false positive mammograms that lead to an actual biopsy are less common in younger women than in older women, which means that younger women may need more extra mammograms or ultrasounds to take a look at a suspicious area but don’t actually have to have a biopsy done when compared to older women where the opposite is true. (In more precise terms, according to the paper, in women ages 40-49, for every case of invasive breast cancer that is diagnosed 556 women have a mammogram, 47 have additional images, and 5 have biopsies.)

While "unnecessary" (which is a laughable word to use in reality) biopsies do happen, we can't pretend they were of no use. They proved there was no cancer a fact most women who have found a lump are happy to hear. I think the issue is we need more specific and better imaging (which is coming by the way). If we focused on better diagnosis based on better imaging we could make these issue nearly moot.

Last point is that genetic testing doesn't give a factual diagnosis. When we put ourselves in the shoes of a female patient who has a "scare" we must understand the concern and fear each individual person has experienced.

"For every seven to 10 women that are being overdiagnosed or overtreated, we're saving one woman's life and I think for me that's worth it," said Dr. Cynara Commer, a professor of surgery at Mt. Sinai's Surgical Oncology Department in New York.

"That's worth finding that one cancer at early stage as opposed to late stage, and the argument that this is saving cost is sort of irrelevant because if we end up finding cancers at later stages, those women have to go much more aggressive treatment," Commer added.
 
:thumbup:

It's sad that the issue of breast cancer has being moved from a medical issue to a political issue. Politicians use their support of breast cancer as a seal of their "pro-women" cred.

1 in 1900 women 40-49 is saved through the current guideline of routine mammogram screening. However, 470 false alarms in every 1,000
. This means needless biopsies and exposure to radiation which also increase one's risk.

I'm not surprised by ACR and Sloan-Kettering stance. I don't think they are looking at this objectively.

Edit: No one is arguing that women in their 40s shouldn't get a mammogram screen but the benefits of routine screening for this age group is what's been debated.
i can't believe i'm actually going to present something here considering the thickheadedness of the OP. but for others' benefit i want to highlight this particular point. the "save" rate is 0.5%, which (haven't read the guideline quite yet) is probably detection rate anyway. in a 1993 JAMA article, the chance of experiencing major morbidity or death in anesthetized ambulatory surgery is 1 in 1366, or 0.7%. seems clear to me.
 
While "unnecessary" (which is a laughable word to use in reality) biopsies do happen, we can't pretend they were of no use. They proved there was no cancer a fact most women who have found a lump are happy to hear. I think the issue is we need more specific and better imaging (which is coming by the way). If we focused on better diagnosis based on better imaging we could make these issue nearly moot.
i like how you keep harping on "facts" yet you give none, and instead use nebulous terms like "lots of women are happy" etc etc. ridiculous. also, if you go in for a mammogram BECAUSE YOU FOUND A LUMP, then it's NOT A ROUTINE MAMMOGRAM. christ you're dense.
 
i like how you keep harping on "facts" yet you give none, and instead use nebulous terms like "lots of women are happy" etc etc. Ridiculous. Also, if you go in for a mammogram because you found a lump, then it's not a routine mammogram. Christ you're dense.
+1
 
And then, almost as if on cue:

Women can wait until age 21 for cervical cancer test, group says

Women can delay having their first Pap test for cervical cancer until they turn 21 and many can wait longer to go back for follow-up screenings, according to new guidelines released Friday by a major medical group.

The American College of Obstetrics and Gynecologists (ACOG) recommended the change after concluding that more frequent testing did not catch significantly more cancers and often resulted in girls and young women experiencing unnecessary stress, anxiety and sometimes harmful treatments because of suspicious growths that would not cause problems.

"We really felt that the downsides of more frequent screening outweighed any benefits," said Alan G. Waxman, a professor of obstetrics and gynecology at the University of New Mexico who led the revision of the guidelines. "More testing is not always more intelligent testing."
 
As others have mentioned the radiation women are exposed to can also have deleterious effects. For example this study suggests that long term exposure to radiation can increase cancer risk. Granted this was for women exposed to radiation starting from adolescence, but the point is that there was a correlation between exposure to diagnostic radiation and incidence of cancer. (I'm sure I can find other studies as well, but this was the first thing I found.)
 
In a society where resource is limited, not putting a price on life (or risk factor) is NOT an opinion anymore. People dont realize that all this is costing some one. If the government/insurace actually give everyone the money and let them decide if they will spend it on the test or buy something else, ALOT more will opt for the later (than if government just reinburse you). So they are putting a price on their own life.
 
i can't believe i'm actually going to present something here considering the thickheadedness of the OP.

i like how you keep harping on "facts" yet you give none, and instead use nebulous terms like "lots of women are happy" etc etc. ridiculous. also, if you go in for a mammogram BECAUSE YOU FOUND A LUMP, then it's NOT A ROUTINE MAMMOGRAM. christ you're dense.

LOL

Well at least you can make those personal attacks :D Glad I can motivate you.

The "facts" have been presented in the article I referenced didn't think it was necessary to present them again (speaking of dense). Just read the study used.

In your haste to call me names you overlooked the idea that the guidelines say to STOP DOING SELF EXAMS. That means you wouldn't be going in after finding a lump! And I'm the dense one!!
 
In your haste to call me names you overlooked the idea that the guidelines say to STOP DOING SELF EXAMS. That means you wouldn't be going in after finding a lump! And I'm the dense one!!

Anyone who is concerned about these guideline changes isn't going to stop doing self exams. And I really can't imagine doctors telling any of their patients not to do self exams. Again, they're guidelines, not a mandate from heaven
 
Anyone who is concerned about these guideline changes isn't going to stop doing self exams. And I really can't imagine doctors telling any of their patients not to do self exams. Again, they're guidelines, not a mandate from heaven

"insert words into mouth here"

What you can imagine and what the general populace does is most likely two different things. I've seen people stick Yankee candles in their anus.... I never imagined that one, I can tell you that.
 
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