A battle over breasts
Friday, November 20, 2009; 9:55 AM
I have never seen a government health-care finding get shouted down as loudly or vociferously as this strange recommendation on mammograms.
Almost in unison, journalists, politicians and ultimately White House officials reacted to the advice that women in their 40s no longer seek breast cancer screening with this question: What were they thinking? (And I'm cleaning it up.)
I understand that there's a serious scientific debate over the positive and negative aspects of mammography, and the don't-worry-be-happy-till-you're-50 finding of the U.S. Preventive Services Task Force grows out of such research. But that brings us to the essential problem with such studies.
In the broad sphere of health care, it may well be that some tests produce minimal returns -- and, worse, might lead to unnecessary surgery, as the task force noted.
But what if the patient involved is your mother, your sister, your daughter? Wouldn't you want her to have the cancer screening? Wouldn't you rather she have the information? What if a mammogram could have saved her life?
The questions answer themselves. Experts can spout off -- and influence insurance company practices -- but in the end it's a very personal decision. The situation is not unlike the debate surrounding prostate cancer and whether regular testing is desirable or potentially harmful. And Friday's recommendation by a medical group that young women wait until 21 to get their first Pap smear has just added to the confusion.
For women, of course, this is not some abstract debate. I've been struck by the highly personal tone some commentators are taking. But it's hardly surprising. If you've had breast cancer, or are worried about getting breast cancer, it's not like writing about Medicare reimbursement rates. You're talking about a clear and present danger.
Little wonder, then, that Kathleen Sebelius wasted no time making the media rounds. The Obama team already had to grapple with the phony "death panels" charge over the summer. No way it wants to be blamed for the actual deaths of women who pass up lifesaving tests.
NYT: "The Obama administration distanced itself Wednesday from new standards on breast cancer screening that were recommended this week by a federally appointed task force, saying government insurance programs would continue to cover routine mammograms for women starting at age 40. . . . Administration officials also fired back against Republicans who argued that the recommendations illustrated the dangers of an expanded government role in medical decision making."
WP: "A top federal health official said Wednesday that the controversial new guidelines for breast cancer screening do not represent government policy, as the Obama administration sought to keep the debate over mammograms from undermining the prospects for health-care reform. . . . While hailed by many patient advocates and breast cancer experts, the new guidelines have been harshly criticized by the American Cancer Society, the American College of Radiology and others, including some members of Congress."
But it is the personal voices that are truly absorbing. Time's Karen Tumulty pronounced herself "flummoxed by this report. I think it proves that even scientists can be pinheads. My issue is not with their recommendations on when and how often women should get mammograms. That seems worthy of debate. What I don't get is their finding that women should not even do self-examinations. And why? Because if we find a lump, it might make us worried. . . .
"That got me thinking a bit about my own history, which on one level might seem to vindicate these findings. I'm a cancer survivor; it has been almost 22 years since I was diagnosed with thyroid cancer, which required surgical removal of my thyroid, followed by two years of radioactive iodine. I was lucky, especially given the fact that the lump in my thyroid had been there for eight years, misdiagnosed as benign.