Make like an ostrich. Stick your head in the ground. Ignore generations of advice from your doctor. And don't worry your pretty little head.
The United States Preventive Services Task Force is certain that if you're a woman in your 40s with no family history of breast cancer, you don't need a mammogram. So forget about it. You can wait. Push it off until you're 50 and instead of annual ones, make them every other year. Listen to the task force. It knows best. Omniscience aside, what's even more troubling is the task force is urging doctors to nix telling women to self-examine their breasts. It's unclear whether the task force thinks physicians should still do breast exams themselves. Is the theory here what you don't check, what you don't know, can't harm you if you stay ignorant?
These are the kind of statements, expressed as "guidelines," that are raising eyebrows and confusion among the 40-to-49-year-old set who now wonder, armed with this "guideline," whether their health plans will deny coverage on the ground that a mammogram is not medically necessary. ConnectiCare president Mickey Herbert tells me his company has no plans, based on a single recommendation, to make any mammogram coverage changes. ConnectiCare was the only managed-care plan that returned my message about this subject, so potentially the jury is still out with its competitors.
The whole point of breast cancer screening is to detect tumors when there are no symptoms. The theory is early detection improves a woman's chances of surviving breast cancer. Private health insurance must cover mammograms for women in their 40s, per state law everywhere except for Utah. Might these guidelines lead to a repeal of some of those mammogram coverage laws? What's next, decline screening for prostate cancer?
Maybe the United States Preventive Services Task Force, supposedly an apolitical group of experts in preventive and primary care medicine, operates with a $7.1 million budget from the Agency for Healthcare Research and Quality. For generations, medical authorities have urged women to have mammograms annually once they turn 40. Now, they're backtracking.
Let's look at the name of this group again: the United States Preventive Services Task Force. It sounds benign. The physicians on this panel are out to help improve women's health, right? Then how does this group reverse long-standing advice to women?
The bottom line of its new guidelines come down to dollars and cents. The number of female lives saved when women start their mammograms in their 40s isn't enough to justify the cost of this procedure. Maybe this body should examine the cost of Viagra next? That's expensive too. But insurers cover it because it's a "quality of life" issue for guys who can't maintain erections. Why is there no mention in this task force's report of the quality-of-life impact of early breast cancer detection? It merely talks about costs versus lives saved, not cost versus quality-of-life maintained among women who, because of early detection and successful treatment, are able to keep more of their breasts.
"This is what happens when epidemiology confronts the personal health needs of individuals. Epidemiologists study the side effects of conferring certain health benefits on the population at large," John Thomas, an expert on health policy at Quinnipiac University School of Law, says. "Epidemiologists looking at the data behind these guidelines realize mammograms save lives, but it costs a lot. The question to them is: `does it save enough lives to justify the expense?' They don't think it does."
Of course, if you are a woman in your 40s, and your life or your breast is saved, you have a different opinion.
The two-year anniversary of my breast surgery is right around the corner. I am a woman in my 40s. Despite having a cousin with no past family history for breast cancer who was diagnosed in her late 20s and again in her early 30s -- first with tumors in one breast, then the other -- her medical problems never prompted me to do regular self exams. Too much work. I'm too busy.
Then, one day, while facing a three-paneled mirror in a dressing room, I noticed that the color of one nipple was different. Weird. It felt like there was something grainy about the size of some coarse sea salt. That led to a mammogram (OK, I was already a year late) and a series of doctors appointments, from my regular one to a breast specialist and a surgeon. The conclusion was there was a dense mass, a tumor that had to come out. It was too large to aspirate. It required surgery.
Bye-bye, sideline as a pole dancer.
Was I worried it might be malignant? You bet. I have a crescent-shaped scar from the operation. And I consider myself lucky. As nerve-racking as it was to wait for my doctors to call me and tell me the biopsy results, consider the what-ifs if this tumor wasn't found for another eight years.
What's more, the task force says these mammograms aren't necessary because of the unnecessary anxiety they may cause women over false positives and additional medical testing. Wow, if that doesn't smack of "we know better than you what's best for you," what does?
From the instant the task force released its new guidelines days ago, it generated controversy. For decades, physicians and health plans preached preventative treatment and early detection to their patients. Breast cancer is the second leading cause of death among women, across all racial groups, after lung cancer. Supporters of the task force's guidelines point out that they were in the works for more than seven years and predate the health reforms now under the congressional microscope.
In 2002, this very task force recommended mammograms for women beginning in their 40s with no prior history. In 2009, the task force, using the very same data and one additional study, comes to a different conclusion. How does this happen?
Angela Mattie, a health care policy expert and professor of health care management at Quinnipiac University, calls the guidelines an "opportunity for women," especially those under 50 who may see their mammography coverage evaporate.
"These guidelines essentially come from the same 2002 data, but come to different conclusions," Mattie says. "This heightens the need for women to be their own advocate for their health care. They need to have meaningful discussions with their doctors, gather information for themselves and make informed decisions about what they need."
That sounds like good medicine anytime.
Connecticut Post Columnist MariAn Gail Brown can be reached at 203-330-6288 or email@example.com.