A new controversy over mammograms could figure big as the health care bill reaches the Senate. (ABC News photo illustration)
Last Friday, another controversial medical guideline was issued: Women should have fewer pap tests.
Just days after there was an uproar over a government task force's recommendation that most women younger than 50 shouldn't undergo mammograms, the American College of Obstetricians and Gynecologists issued new guidelines stating that when it comes to cervical cancer, women should wait until age 21 to have their first Pap test; previously it had recommended that women get their first test three years after becoming sexually active or at age 21, whichever came first.
Also, women younger than 30 should be screened every two years rather than annually, and those older than 30 should be tested every three years, rather than every two to three years, after they've had three normal Pap tests in a row.
The guidelines don't apply to women with a higher risk of cervical cancer.
The chairwoman of a panel in the obstetricians' group that came up with the guidelines recognized it might look strange that the mammogram and Pap recommendations came out so close to each other but insisted it was merely a coincidence. Plus, the group insists the new Pap recommendations are different because there's broad agreement among medical groups.
Sure, some doctors say many women go to a physician only once a year for the Pap test and might forgo preventive medicine if it's seen as less urgent. Still, it has become clear that cervical cancer develops slowly, so there's no reason to screen annually, and many problems detected by the Pap resolve on their own, meaning that thousands of women undergo unnecessary procedures that can injure the cervix or lead to problems during pregnancy.
Meanwhile, the federally funded group that upended long-standing guidelines for breast cancer exams says critics have misinterpreted the mammogram report.
The federally funded group that upended long-standing guidelines for breast cancer exams says their recommendations have been misunderstood by opponents, some of whom have accused the task force of encouraging the rationing of health care.
A panel member tells the Wall Street Journal "the task force is not against women having mammograms in their 40s" but instead reversed earlier recommendations that doctors automatically give those women annual X-ray mammograms. But "[w]e probably, in retrospect, could have been more clear" and did not anticipate the subsequent uproar, she concedes.
Panel members also noted that "they voted on the new guidelines in June 2008, says the Journal, months before President Obama was even elected." Others critics have blamed the group for not including any oncologists among the members.
So here's were we are now: The two separate medical recommendations last week that women shouldn't undergo screening for breast and cervical cancer as frequently as previously recommended have been met with confusion and anger from some corners, not to mention a measure of political posturing. Supporters of the recommendations insist they're just good science, but they've flummoxed patients who have been led to believe that when it comes to screening, more is better.
But the Atlantic magazine reports that as far as the mammogram recommendations go, there's little question that they're right on the money. It may have seemed like it came out of the blue, but the data have been available since March 2002. The truth is the media just aren't very good at explaining what all the different numbers mean and how little absolute benefit there is from mammograms.
In Sweden, for example, regular mammograms became available to nearly all Swedish women, yet the national breast cancer death rate fell by a mere 2 percent, "or less than one fewer death in every 100,000 women," notes the magazine.
The outrage that develops when it was suggested that screening should be pared back is nothing new, writes Robert Aronowitz in a NY Times op-ed. Throughout the past 100 years, he writes, people have wanted to believe that screening has a much more net positive effect than it really does.
The Times also talked to experts who say the uproar over last week's studies shows how the public and politicians need to be educated to the fact that screening can be "a two-edged sword," as one expert puts it. "Yes, it helps some people, but it harms others."
Dr. Aronowitz
FYI: Aronowitz is no slouch: An MD from Yale, further training at the Robert Wood Johnson School of Medicine (where he later taught), he's currently professor of the history and sociology of science at the University of Pennsylvania, and he's studied the last 60 years of societal and biomedical responses to pronouncements and guidelines about screening tests and risk-reducing drugs, and how values and interests of various stakeholders influence how we recognize, name, define, and respond to health risks.
What you begin to wonder in the administration of these tests is whether there are two groups being extra cautious: The patients and the doctors. Imagine the doctor who advises against the mammogram and the patient gets breast cancer at 46. Guess what's coming?
It's unlikely anyone will admit it publicly, but instead of cutting costs as skeptics wonder, or so-called "death panels" as far right conservatives suspect; maybe these new guidelines are about protecting doctors who don't think every medical test is necessary but they give them anyway because they don't want to get sued.
The last people we want being motivated by fear are doctors, but that does seem to be part of the landscape we've carved out in our litigious society.
Comments
My mother was diagnosed with lung cancer in February this year. She was 80 yo. The choice between surgery and chemo was still medically questionable. She saw friends go through chemo and saw them get no better only to die anyway. She insisted on the TWO more tests her oncologist said would rule in or out the operation.
Medicaid denied paying for those tests in favor of the chemo. All this was due to her heart condition and her age.
She insisted and fought only to DELAY her treatment for 2 months and finally she succeeded in getting the 2 tests Medicaid denied paying for. Both tests showed she was a candidate for surgery.
She avoided the dreaded chemo and got the lung operation. She came out cleaned of cancer in her lung and at 80 years old went on her decades old summer long camping trip, by herself and volunteered at the state park's nature center at the beach where she camped for the summer. She died of a heart attack during her last week of vacation.
She is missed.
For those who keep blaming Republicans you better get off that 'high horse" This bill is the equivalent of throwing the baby out with the bath water- the cart before the horse- If your house needed work would you knock the whole thing down? Reform is needed, but not at the expense of killing more jobs. How the heck would you get successful reform if you eliminate small and large business who are paying for this? With higher taxes they won't have money to 'reform' anything. It is a backwards movement- illogical, and insane. Pushing it down Americas throat to appease Obama is the death of America, literally.
Jack -- "This bill is the equivalent of throwing the baby out with the bath water"
I don't think you can make those claims with any credibility. None of the Republicans currently playing the fear card can say with certitude that their predictions will come true. I see this bill --I hope-- as the first step towards true meaningful reform. Did you know Mary Landrieu got $300 million for her state for her yes vote to bring the reform bill to the floor? That's how lawmakers see this bill now --what's in it for me so I can keep my job. Landrieu faces re-election next year. She needs chips to sell to voters. So we're a long way from where this bill will take us, but it's a step. We put this off once before --same arguments. No more. But check my "Health Care" file in the tab on the right. I've written about the small business problem you noted MANY times. When enough of THEM drop coverage for employee, THAT's when we'll really see some angry voters.
Chef Dad: I'd like to use your mom's story as the basis for another article. Would you be okay with that?
Bruce, it depends on the treatment my late Mom would receive from you. I am concerned with some of your past posts and ideology.
Got something to say?
Examiner.com is looking for writers, photographers, and videographers to join the fastest growing group of local insiders. If you are interested in growing your online rep apply to be an Examiner today!