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Are the new mammogram screening guidelines an example of rationed health care?
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For months, older men have been told that prostate screenings are not beneficial. Now, the new mammogram screening guidelines are indicating the same. Are these government task force messages a result of weeding out inadequate screening technologies or an example of rationed health care?
There is no denying that even with regular exercise and a healthy diet consisting of cancer-fighting foods and antioxidants, breast cancer diagnosis and death rates, especially for young women, are increasing. Now that the task force members have rendered breast self-exams, clinical exams, and mammograms as non-beneficial, are we replacing the notion of technologies that advance healthy living with rationing? Dr. Susan Love, renowned breast surgeon and activist, admits that "this is rationing of the best kind" since the guidelines were based on scientific data. Yet, the data that was considered by the task force was from 2002 - digital mammography has become more accurate since then.
"I absolutely believe this could be a form of rationing," said Rep. Phil Gingrey, R-Georgia, a practicing obstetrician and gynecologist for 26 years. "It scares me." Rep. Phillip Rose, R-Tennessee, a retired obstetrician and gynecologist who stressed that some of the most aggressive cancers are found in younger patients added, "we've spent years educating women and the public to do this early detection and now we've just taken a 180 and turned the other way."
If this isn't myopic cost-cutting, then the task force would have considered the public health interest and recommended other breast cancer screenings that are more accurate for younger women, namely sonograms and breast MRIs.
"The government-run insurance companies are definitely going to be using these federal guidelines as opposed to using the American Cancer Society guidelines…I think it's coming down to saving costs. I don't think we should be doing that at the expense of women," said Dr. Cynara Commer, a professor of surgery at Mt. Sinai's Surgical Oncology Department in New York. She is very concerned that the "new guidelines are the top of a slippery slope toward rationing, and questioned the timing as the Senate is about to vote on health care reforms that could end up containing a so-called public option."
"These new recommendations seem to reflect a conscious decision to ration care," said Dr. Carol Lee, chairwoman of the American College of Radiology Breast Imaging Commission. She also added that "since the onset of regular mammogram screening in 1990, the death rate from breast cancer, which had been unchanged for the preceding 50 years, has decreased by 30 percent."
One of the bodies the task force has influenced over the years is the insurance industry. These recommendations may provide the substantiation for some private insurers to cut back coverage for annual screenings, particularly for young women.
"What is going to happen is insurers are going to say, 'the (task force) doesn't support screening; we're not going to pay for it,'" said Dr. Daniel Kopans, professor of radiology at Harvard Medical School and a senior radiologist at Massachusetts General Hospital in Boston. He also added, "there was no new data to assess. One has to wonder why these new guidelines are being promulgated at a time when healthcare is under discussion and I am afraid their decision is related to saving money rather than saving lives."
USA Today reported that there's no way to predict how private insurance plans will respond. "The recommendations could affect West Virginia, whose law on mammogram coverage is tied to task force recommendations. (Currently), the task force's recommendations have no direct effect on Medicare coverage of mammograms. That's because Medicare is required by law to cover one screening for women ages 35 to 39, and yearly mammograms after that. (However), Medicare's mammogram coverage can be changed in one of two ways: Congress could pass a new law, or the secretary of Health and Human Services could change coverage, after consulting the head of the National Cancer Institute."
In the end, because breast cancer kills more than 40,000 women each year, women have to be their own health care advocates. It is still imperative to discuss the benefits and risks as well as your personal needs for a mammogram, sonogram, clinical breast exam and breast self-exam regimen with a doctor.
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