If you’ve been watching the news, you may have seen some historic changes in recommendations about cancer prevention. There have been news releases regarding a change in the recommendations for mammogram screening by the US Preventive Services Task Force (USPSTF). Women in the 40-50 year old age group are now only encouraged to have regular mammograms if they are at increased risk of breast cancer, due to the fact that this test often finds non-existent of unimportant abnormalities in this age group that, on the whole, makes them less, not more, healthy. This will save women thousands of dollars and countless hours of time and energy at a time in their lives when that time and energy is a real gift.
Today I read that the American College of Obstetrics and Gynecology now recommends starting pap smear screening at 21 for most people, and reducing the frequency in that first decade to every 2 years. I have studied evidence based recommendations for pap smears for years, and the formula that makes sense is somewhat more complex than this, but in most cases our standard yearly pap smears are not necessary. This is based on the fact that some of the treatments for abnormal pap smears can make a women less healthy, less fertile, and that the whole process is expensive enough that honing it down to what is truly necessary makes excellent sense.
Cost is certainly not the only issue here, but diversion of significant money from womens’ health funding in directions where it does no good hurts all of us. Google tells me that a mammogram costs around $100, and may cost as much as $200, and a pap smear runs about the same price. The cost of these tests in terms of comfort and dignity is not insignificant.
I have already seen what seems to be a knee-jerk “you want to let women die to save money” reaction to these new recommendations. i haven’t studied the numbers yet to see if there is actually more of a risk or a benefit to the new schedule. It would appear that it would certainly save money.
We have loud voices demanding comprehensive, high quality healthcare for all. We have not-quite-so-loud-yet voices demanding lower cost healthcare. The two voices need to stop talking at cross purposes and engage in a conversation. We need to decide what should be provided to everyone, how much it will cost if provided in an efficient fashion, and how we will pay for it. “Tax the ultra-rich”, while an enticing plan in theory, never seems to work out in practice.
A schedule of screening tests based on evidence for what is necessary, and, yes, cost effective is not such an unreasonable approach.
The arguments for getting Pap smears and mammograms less often all seem to rest on the bothersomeness of false positives. I’ve been through three false alarms on my mammograms, and I still think it was worth it, even though the process of getting them checked out was cumbersome and unpleasant. I suspect most women in my position would agree. Don’t we have the right to make that choice for ourselves?
Isn’t there a middle ground? The doomsayers seem to be missing that coverage for “minimum recommeded” tests would change, but any woman desiring (absent other risk indicators) additional tests is welcome to get them at her own expense.
The emotional disconnect makes me both angry and sad. No test is 100% accurate, yet some who require frequent reassurances will complain about accuracy even while demanding that science be ignored.
My mother had a radical mastectomy with radiation therapy. All of my sisters found a way to get annual mammograms ever since she was diagnosed, whether they had coverage to pay for them or not. That is a far cry from the general population of women who are afraid. We can acknowledge and show sympathy for their fear, but we should not throw money at them that we know will be wasted.
Insurance coverage has not been based on these groups’ recommendations, and probably won’t be, since there is variation in opinion, so yes, you can decide how often you want a mammogram. And what’s good for a population is not necessarily good for an individual, so we ought to be making our own, informed decisions on all of this.
And to Pat–I agree. The cool thing is that reducing waste in health care WILL improve quality, so both high quality and low cost can happily co-exist. When I spend time with a patient chasing false positive results on mammograms or paps, we don’t have time to focus on what is important to that patient. And if we insure everyone, we are really going to need the resource of time.
The idea of false positives and too much medicine can be harmful is a difficult one to communicate. People just assume that faster and more is better. So much of what is done in medicine adds little that is positive and just incurs risk. Small risks add up.
Steve
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It should be left up to the doctor when they should be done.
Is this the begging of Obamarationing?