Test-Marketing Health Care Rationing?

Or at least the pressure is.

As you’ve probably already heard, a government task force (whatever THAT is) has recommended that women under 50 forego routine mammograms. The US Preventive Services Task Force has suggested that these screenings can lead to false alarms, “unnecessary” biopsies and additional unnecessary mammograms after the alarm is first raised.

This is not only stupid, it’s dangerous. Were it not so serious, it would also be amusing, considering all of the chatter about preventive care we have heard from President Obama and his acolytes since they began their attempt to shove the “health care” bill down the throats of an unwilling nation. Indeed, the President specifically mentioned mammograms.

But now his task force is citing unidentified, greater “harms” to women who are screened before the age of 50, and even that women 50 and above only get mammograms every other year. This is the same task force, by the way, that recommended but six months ago that women over 40 be sure to get their mammos every one to two years.

So that’s the story. And here’s why it’s bull, and I know because the spectre of breast cancer was almost very, very personal just a year ago.

For one thing, I’ll tell you that I tend to agree with physicians who aren’t fans of mammograms alone, because they really aren’t the best method of detection (and that remark has little to do with the discomfort involved). Ultrasounds are almost certainly better, and clearly a lot less painful. Furthermore, mammograms are often difficult to read in younger women due to the greater density of the breast tissue.

However, these recommendations still seem unwise because some hospitals won’t do ultrasound-only, and prefer to do the mammo or both. Let’s be honest: it’s difficult to get a breast ultrasound alone, despite its superiority, because many doctors still insist upon the mammogram first. Why are we cutting off the first route to discovery for so many women, then? Breast cancer is the second leading cause of cancer deaths among women and seventh overall.

Also disturbing is that many women, hearing these new guidelines, may simply decide not to seek out a screening, even if they or their spouse do find a lump or notice other signs that often point to breast cancer or tumors. Due to the unpleasant aspects of mammograms, many women already don’t have them done. Let’s not make this worse. Again: breast cancer is a killer.

Moreover, this clearly, clearly sounds like rationing to many, and not without reason. That these new guidelines exist are already causing some to fear that insurance companies will stop paying for mammograms received or requested by women under 50. It might sound crazy, but as PoliPundit found, the conclusions reached by this task force will set the standards for what is and is not covered by insurance plans, private or “public”.  Shouldn’t the decision to check for possible cancer be between a woman and her doctor (and for that matter, whether it’s a mammo or an ultrasound)? Moreover, since this president is the same one who told us that “will to live” means nothing, and that past a certain age people should not expect to receive expensive medical care, only a painkiller, what is to stop this panel from recommending Tylenol for women over the age of, say, 55 who have been diagnosed with breast cancer?

Well?

Again, this panel is recommending against routine screening, explicitly the opposite of what BHO has promised. Will it be mammos today, ultrasounds tomorrow? Furthermore, though they say that these guidelines don’t apply to women with a family history or suspicious symptoms, how will those be defined? Also, 75% of women with breast cancer have NO family history of the disease.

Finally, though it is suggested that older women get screened for breast cancer regularly, the fact is that 23% of all breast cancers attack women under the age of  49. Perhaps worse is the fact that for whatever reason, breast cancer also tends to be extremely aggressive in younger women, resulting in more young, under-49 women dying from this disease. You can see why, then, that keeping an eye out for cancer in young women is especially important. But if a woman hears that she needn’t really worry about breast cancer screenings until she’s 50, might she let signals like breast pain, lumps, or other changes go unacknowledged until her next gynecologist appointment—at which point it’s too late? Because it has happened, and it’s very possible. In younger women especially, time is of the essence.

I speak from experience. Some of you know that last fall, we had a major breast cancer scare here. Not only am I young, it runs in the family and, in fact, killed my maternal great-grandmother. Very close female family members have had (and, thank God, beaten) breast cancer or had tumors removed.

My doctor, understandably, rushed to get me in for a mammogram (FUN) and ultrasound. When the hospital gave me trouble (as in, they didn’t ever return my calls requesting an appointment), he sent me to another, more responsive hospital to get me started. Five—yes, FIVE—erm, crushing experiences (after which the ultrasound was akin to an expenses-paid vacation in whatever paradisiacal location you prefer), one 20-minute long MRI (not open, yikes), endless driving all over greater Pittsburgh, and some slightly unnerving days later, the breast surgeon to whose office I was sent gave me the all clear. Benign. Remember? Bullet, dodged.

In each place, before the surgeon’s office, I could see a slightly greater edge of fear and extra dose of compassion in the eyes of the nurses and doctors meeting with me, greater than what they had with the other patients I saw go in, and it was doubtless because I’m at high risk already, then young on top of it. It was…discomfiting, and I’m not easy to unsettle when it comes to health issues. The surgeon was truly, visibly happy and relieved when he told us that everything was okay; makes me think some of these folks had recently dealt with young women who weren’t so blessed as I was.

Obviously, then, my own personal experience has some bearing on this discussion, but even that is only because last year I underwent a crash-course. That aside, though, we all know women who disdain any breast screenings whatsoever, either out of ignorance or fear. It’s had to say. But now, will doctors stop reminding women that this is indeed something they need to be concerned with? Insurance companies certainly won’t be able to compete so far as premiums go should the government plan not cover mammograms and other screenings prior to the age of 50, so they’ll have to drop this coverage or deal with the wrath of those whose premiums have increased.

Again, I’m not a fan of mammos and the radiation involved, to say nothing of the physical vexation; to my mind, ultrasounds are far better. But a quick blanket statement is obviously leading many astray here, and those who don’t bother to read the stories could well think that no screening of any kind is necessary or even recommended. Bad idea.

In the meantime, in the names of cost savings and less ‘anxiety’, women will inevitably be denied the screening or told it’s not necessary even if they request it, and some of them will die, leaving behind families and even children.

Looks like a preview of government managed care, where numbers are all that matter, the panels can’t be argued or pleaded with and cash payment for procedure is out of the question: humanity be damned.

(Note: I’ve read around the web that similar recommendations were given for men’s prostate cancer screenings. While confessing to not being as knowledgeable about prostate cancer’s speed of attack, the same principle should apply: if a patient and doctor agree there’s a need for the screening, then perhaps they know better than third parties. Moreover, a DRE—sorry, fellas—is fast, simple, and inexpensive. Not sure about the PSA, but frankly, blood tests are also fairly painless, fast, and inexpensive. Both are…um…well, there’s no radiation involved, though invasive after a fashion—again, sorry, men. Just want to throw that in in the interest of balance.)

(And in the interest of fairness, anyone going in for a mammo or DRE should be given their choice of adult beverage prior to the exam.)