Interesting... Gov't and cancer?

[Gewehr98]

Oh, sorry.

Breast cancer.

Funny.

Ha-ha.

[Headless Thompson Gunner]

Yes.  In almost all cases, the long-term risk to the patient is greater by declining the biopsy.  Just due to the chance that it might be a serious problem.

That makes perfect sense.  The risks of cancer are significant, best to have the procedure and know for sure.  The consequences of not knowing could be extreme.

Which brings us back to my original interest in the topic.  Why is FedGov now recommending against knowing for sure?  You yourself say that the long term health risks of skipping the procedure are greater than the risks of having the procedure.  

It doesn't add up.  And it's darned creepy to hear the government telling you that you're better off not knowing you have a life-threatening health problem, when all it takes to learn the truth is a routine medical procedure.

[Headless Thompson Gunner]

Oh, sorry.

Breast cancer.

Funny.

Ha-ha.

Naughty parts are always funny.

[MillCreek]

The Federal Government is not necessarily recommending anything.  The USPSTF is a group of independent physicians and researchers that get some funding from the Feds.  The Feds do not control or mandate the findings and recommendations of the USPSTF.  They are an independent public health body that is very well respected in the world of medicine.  The issue of screening, routine and preventative care is their forte.  They try to figure out what tests or procedures should be done when and to whom, in order to eliminate useless or wasteful care and deliver quality and cost-effective care.  This group was one of the key players in coming up with the recommendation for screening colonoscopies at age 50, for example. 

Most breast cancers are slow growing enough and start late in life such that screening, as opposed to diagnostic, mammography can safely be deferred to age 50.  While some women get breast cancer under age 50, the absolute numbers are very small.  From a cost benefit analysis, the risks of radiation and potentially-unnecessary biopsies in women under age 50 are greater than the number of cancer deaths prevented in women under age 50. 

My comments on the long-term risks of skipping a biopsy pertain only to the situation in which we know there is a suspicious lesion.  How many mammograms have to be done under the age of 50 to find one suspicious lesion?  If it does not make much of a difference in outcome and survival, can we find better uses for that money elsewhere in the health system? 

Of note, so far, the articles are saying that the insurance companies will still pay for mammograms starting at age 40.  So if a woman wants one, she get it, and get it paid for by insurance.  And if you have risk factors for breast cancer, you can get a mammogram at any age paid for by insurance.

The same argument is made for doing chest CT scans in smokers.  The number of scans you have to do and the number of subsequent biopsies you have to do to save one life from a lung cancer death is just enormous.  Can we as a nation afford that?  Anecdotally, the media can always find a case or two to say that mammography/chest CT scans/PSA testing saved my life at an early age, but the preponderance of the statistics say that when you look at the population as a whole, some types of screening do not save lives, are risky to patients and essentially waste money. 

Back when PSA testing for prostate cancer first came out, providers were gung ho to start doing them at age 50.  But a funny thing then happened, the data showed most prostate cancer cases only came about at ages starting in the mid 60's, and most men died from other causes first rather than prostate cancer.  A lot of men underwent biopsies and surgeries with some significant side effects to treat early prostate cancer.  They suffered significant problems from overtreatment.  The initial enthusiasm for early PSA screening as worn off, and now, depending on your age and the size of any lesions, many men are opting to not treat it at all or to try less aggressive means such as radiation or chemo, as opposed to surgery that leaves you impotent and incontinent. 

The best advice I give to people is to talk with your provider about screening tests.  See if they are recommended for your particular situation. 

[Balog]

Hi Mrs Physics, nice to see you. Congrats on the new arrival! What is an ND, I am unfamiliar with that abbreviation (at least in a medical sense) :D. Perhaps you might like to join our little family here with your own account?

As for the OP, I must say I find a lot of sense in MillCreek's arguments. Much as I'd like to be all "zomgdeathpanelseleventyone" about this, it appears to be a fairly routine change in screening procedures.

[RevDisk]

What is an ND, I am unfamiliar with that abbreviation (at least in a medical sense) :D.

Doctor of Naturopathic Medicine, perhaps.

[MillCreek]

Yes, Ms. Physics is a naturopathic doctor.  NDs are popular up in the Pacific Northwest, especially those people who are suspicious of conventional allopathic medicine or prefer a more 'natural' approach.  There is a leading naturopathic medical school just 14 miles from my house.  Bastyr University, and I have gone there several times over the years to guest lecture the students about malpractice and medical liability issues.

[MillCreek]

I cut and pasted the article abstract below.  The full article can be read in today's edition of the Annals of Internal Medicine found here:  http://www.annals.org/content/151/10/716.full


Clinical Guidelines
Screening for Breast Cancer: U.S. Preventive Services Task Force Recommendation Statement
U.S. Preventive Services Task Force*
+ Author Affiliations

From the U.S. Preventive Services Task Force, Agency for Healthcare Research and Quality, Rockville, Maryland.
 
Next Section
Abstract

Description: Update of the 2002 U.S. Preventive Services Task Force (USPSTF) recommendation statement on screening for breast cancer in the general population.

Methods: The USPSTF examined the evidence on the efficacy of 5 screening modalities in reducing mortality from breast cancer: film mammography, clinical breast examination, breast self-examination, digital mammography, and magnetic resonance imaging in order to update the 2002 recommendation. To accomplish this update, the USPSTF commissioned 2 studies: 1) a targeted systematic evidence review of 6 selected questions relating to benefits and harms of screening, and 2) a decision analysis that used population modeling techniques to compare the expected health outcomes and resource requirements of starting and ending mammography screening at different ages and using annual versus biennial screening intervals.

Recommendations: The USPSTF recommends against routine screening mammography in women aged 40 to 49 years. The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take into account patient context, including the patient's values regarding specific benefits and harms. (Grade C recommendation)

The USPSTF recommends biennial screening mammography for women between the ages of 50 and 74 years. (Grade B recommendation)

The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years or older. (I statement)

The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination beyond screening mammography in women 40 years or older. (I statement)

The USPSTF recommends against clinicians teaching women how to perform breast self-examination. (Grade D recommendation)

The USPSTF concludes that the current evidence is insufficient to assess additional benefits and harms of either digital mammography or magnetic resonance imaging instead of film mammography as screening modalities for breast cancer. (I statement)

The U.S. Preventive Services Task Force (USPSTF) makes recommendations about preventive care services for patients without recognized signs or symptoms of the target condition.

It bases its recommendations on a systematic review of the evidence of the benefits and harms and an assessment of the net benefit of the service.

The USPSTF recognizes that clinical or policy decisions involve more considerations than this body of evidence alone. Clinicians and policymakers should understand the evidence but individualize decision making to the specific patient or situation.

[grey54956]

Uh-oh... plot is thickening...

http://news.yahoo.com/s/nm/20091120/hl_nm/us_cancer_cervical_screening

New guidelines push back age for Pap smears

By Julie Steenhuysen Julie Steenhuysen   – 2 hrs 40 mins ago

CHICAGO (Reuters) – Women in the United States should start cervical cancer screening at age 21 and most do not need an annual Pap smear, according to new guidelines issued on Friday that aim to reduce the risk of unnecessary treatment.

The guidelines from the American College of Obstetricians and Gynecologists or ACOG now say women younger than 30 should undergo cervical cancer screening once every two years instead of an annual exam. And those age 30 and older can be screened once every three years.

The recommendations are based on scientific evidence that suggests more frequent testing leads to overtreatment, which can harm a young woman's chances of carrying a child full term.

"Overtreatment of minor abnormal pap tests in young women and adolescents can lead to consequences such as preterm labor in some cases. It increases the risk," said Dr. Thomas Herzog of Columbia University in New York, who is chairman of an ACOG subcommittee on gynecologic cancers.

"Preterm delivery has become a huge problem in the United States that has potential serious consequences for the unborn fetus," said Dr. Jennifer Milosavijevic, a specialist in obstetrics and gynecology at Henry Ford Health System in Detroit, who supports the guideline changes.

AVOIDING UNNECESSARY PROCEDURES

"These new guidelines will allow us to avoid doing unnecessary procedures on the sexually active adolescent female," she said in an e-mail.

The guidelines are unlikely to be met with the kind of rebellion that accompanied new breast cancer screening guidelines this week, which were largely based on computer projections, Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society, said in a telephone interview.

"There is a lot more agreement about the science of cervical cancer screening," Lichtenfeld said.

Prior recommendations called for annual cervical cancer screening to start three years after a women first becomes sexually active, or by age 21. Although the rate of HPV infection is high in this population, rates of cervical cancer are very low.

Herzog said the new recommendations are based on studies that suggest starting screening earlier than age 21 causes more harm than benefit.

"We were overdiagnosing and overtreating adolescents and very young women," Herzog said in a telephone interview.

Cervical cancer is a slow-growing cancer caused by exposure to certain strains of the human papillomavirus (HPV), a common sexually transmitted disease among women and men.

"Women do not get cervical cancer first. They acquire HPV, the sexually transmitted virus that causes precancerous abnormalities of the cervix and cervical cancer. It takes years to progress from an HPV-infection to full-blown cervical cancer," Milosavijevic said.

For that reason, she said changing the screening interval will not mean more cervical cancers will be missed. She said most deaths from cervical cancer in the United States happen in people who are screened infrequently, or not at all.

"The take-home message for women is that you should still get your pap smear screening," Milosavijevic said.

HPV is the most common sexually transmitted disease in the world. About 20 million Americans currently are infected with HPV, according to the CDC.

In the past 30 years, cervical cancer rates in the United States have fallen by more than half, due in large part to widespread use of cervical cancer screening.

(Editing by Todd Eastham)

---------------------------------------------------------------------------------------

Look, I know my tinfoil hat has been on tight lately  ...  but, doesn't this strike anybody as odd.  Two suggested reductions in cancer screening in the same week?  Could be cost savings, or it could be that they really aren't all that necessary.  Statistics may show little benefit to frequent screenings, but statistics are great until you become a statistic.