Congress Slams Panel for New Mammogram Guidelines

cp418

http://abcnews.go.com/Politics/congress-slams-mammogram-guidelines-health-care-debate/story?id=9227203

gpawelski

Eleven Health & Prevention Organizations Defend USPSTF, Mammogram Recommendations in Letter to Congress

http://www.prnewswire.com/news-releases/11-health--prevention-organizations-defend-uspstf-mammogram-recommendations-in-letter-to-congress-78323577.html

Merilee

Good grief

TenderIsOurMight

TenderIsOurMight

http://www.youtube.com/watch?v=fzw9TfbI17M&feature=player_embedded#

 Well, no rocket scientist here (i.e, me. Sorry, you'll have to cut and paste, but worth viewing imo.

yellowrose

I watched CSPAN for much of this congressional meeting.  This Youtube edited version doesn't  do it justice.  I'm proud of the stance that Burgess and Shimkus took.  Burgess asked some probing questions about the type of physicians on the panel and more pointedly who wasn't on the panel but who the USPSTF "consulted" before making the final recommendations. 

I still don't get the recommendation to physicians to stop teaching BSEs.  Even the physicians testifying didn't explain it well and seemed rattled several times during questioning.

AnnNYC

Great essay about the bumbling of the USPSTF (a friend directed me to it) in an oncology statistics journal:

http://www.oncologystat.com/news-and-viewpoints/viewpoints/commentary/Why_the_USPSTF_Mammography_Screening_Recommendations_Sparked_Such_Controversy.html

You might have to register to read it, but registration is free.

A few paragraphs:

Although the evidence for or against the value of CBE is incomplete, full physical examination by a health care provider remains a central pillar of routine health maintenance. It makes little sense to draw attention to the fact that RCT evidence is lacking when CBE can easily and inexpensively be incorporated into routine health care practice. This serves as an egregious example of the adage "absence of proof is not proof of absence of benefit," and yet a cursory reading of the paper suggests that the task force is coming out against this basic examination.

Similarly, while there is some evidence that in non-US populations BSE does not reduce mortality, it's entirely possible that routine examination could increase women's awareness and prompt evaluation not only of their breasts also but of other health issues. BSE costs nothing and empowers women in their care. What was rationale behind the task force's decision to actively recommend against use of BSE as a preventive strategy?

iodine

I thought they advised that it was not a good use of the doc's time to TEACH BSE, not for him/her to Stop doing clinical exams. 

AnnNYC

Dotti, you're right that they recommended AGAINST doctors teaching BSE, saying "The USPSTF recommends against clinicians teaching women how to perform breast self-examination. (Grade D recommendation)." 

What they said about clinical breast exam (CBE) was:

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

And also:

"There is adequate evidence that teaching BSE is associated with harms that are at least small. There is inadequate evidence concerning harms of CBE. "

"For the teaching of BSE, there is moderate certainty that the harms outweigh the benefits."

"For CBE as a supplement to mammography, evidence is lacking and the balance of benefits and harms cannot be determined."

http://www.annals.org/content/151/10/716.full

Fidelia

Actually - I think this whole debate about appropriate detection is a bit of a waste of time and has distracted a lot of good people from the main game - CURING cancer. It seems very much like a spin-doctors response to a gut-deep rejection by people of any detailed analysis which seems to fly in the face of commonsense. Cancer caught earlier is only part of the deal - BUT it is an important part in most cases. Trying to skimp on the cost of detection as a way to save money was never going to convince people these days - too much evidence that early detection DOES save lives - not all but many - and that should be justification enough.

Now everyone is backing away from the panel and their convoluted logic - what people should be more concerned about is that rather than offering MORE money for research and greater access to the technology already available - the dialogue has been spun down a blind alley.

Everyone should sober up and get back to work on the cure - nice try penny pinchers - it didn't work - now back to the bench and put effort and money where it is needed - saving lives!

gpawelski

Many years ago, the National Cancer Institute tried to convince everyone not to screen women younger than 50 but were given such a tongue lashing by Congress that they went home, licking their wounds and withdrew their recommendation.

Likewise, the American Cancer Society (ACS) avoids looking clearly at the data and continues to recommend screening for women under fifty. The ACS doesn't want to enrage its donor base and Congress didn't want to upset constituents and breast cancer specialists have faith in the procedure.

Dr. Otis Brawley, the cancer society's chief medical officer, was quoted in the New York Times admitting "that American medicine has overpromised when it comes to screening. The advantages to screening have been exaggerated." This is the same view he expressed at a cancer symposium in Milan back in 2003.

Following the task force report's release, however, Brawley changed direction, telling the Times that the cancer society had concluded that the benefits of annual mammograms beginning at 40 "outweighed the risks" and that the ACS was sticking by its earlier advice. One of Brawley's colleagues said, "He's trying to save his job. He was broiled at home for the interview in which he said that the medical establishment was 'overselling' screening."

And Health and Human Services Secretary Kathleen Sebelius told American women that they have nothing to learn from the science that led to the USPSTF guidelines on mammography. I guess the President didn't want to upset his constituents.

We would like to believe that medical advice we get is based solely on good medical practice and evidence-based medicine. It is important to note that companies like General Electric and DuPont, both which manufacture mammography equipment, are large donors to organizations, such as the American Cancer Society, that are aginst any change in the recommendations.

The US Preventive Services Task Force (USPSTF) is not the US government or a panel of government officials. The task force is made up of independent primary care doctors and others whose stated interests include decision modeling and evaluation, effectiveness in clinical preventive medicine, clinical epidemiology, and the prevention of high-risk behaviors.

Research by the Nordic Cochrane Centre in Denmark raised questions about the effectiveness of mammography. In a study of 2000 women, they found that one woman would have her life prolonged but 10 would undergo unnecessary treatment and 200 women would experience unnecessary anxiety because of false positive results. According to the authors of the study, it is "not clear whether screening does more good than harm."

According to Dr. Donald Berry, head of biostatistics at the M.D. Anderson Cancer Center, if the data is read carefully, the benefit for women 40-50 is really only 9 percent, which is not statistically significant, meaning it could represent the play of chance and not a real advantage.

The recommendation not to begin mammography until age 50 has to do with medical issues, more than cost effectiveness issues. Mammography is not harmless. You are subjecting 1,899 women to annual doses of ionizing radiation to the breasts, with some unavoidable scatter to chest wall and lungs.

We do not know how many women who are irradiated by mammography in their 40s will develop radiation-induced breast cancer (or even lung cancer) in their 60s, 70s, and 80s.

The other problem is that women in their 40s tend to have very dense breasts, making it more difficult to get an accurate exam. These women often are called back for "additional views," giving them even more radiation. There are more false positives, leading to breast biopsies and sometimes unnecessary lumpectomies, in cases where the biopsies are technically suboptimal.

In contrast, in older women, their breasts are less dense, making the examination more accurate, with fewer false positives, and there are fewer years of remaining life to develop a radiation-induced malignancy.

I would not want to see the "politics" of the American Cancer Society trump over "science."

cp418

I was diagnosed with IDC in my 40's only detected by mammogram.  I will be overcome with joy if I can live to my 60's, 70's or 80's.

iodine

I've read the ACS MD"S quotes before.  I feel there is a very large difference between  the statements: "over promised and exaggerated the benefits of screening" and "benefits outweigh the risks" of screening.

Yes, as with almost all new techniques/ologies, mammos were thought to be all that and a bag of chips, but as medical science, will, when it's progressing, it found that they over promised the success of mammos. What that now tells us is:  We need Better diagnostic testing for bc, NOT that we need to QUIT using mammos.

 On the other hand, benefits outweighing the risks, has to do with everything in medical treatment.  It all comes with risks, and WE have to decide if the benefits outweigh those risks ---when we take birth control pills, chemo, blood pressure meds, blood thinners, ASPIRIN, for goodness sakes.  If you read all the possible outcomes of taking tylenol, and felt they would happen to you---you'd feel you were being murdered.  If you sign a surgical release and read and believe you could have any of the possible poor outcomes, you would actually be considered crazy and benefit from a psych consult.  Who in their right mind would agree to a procedure that could cause Death!  Except someone who, if they did Not get the surgery, could almost count on dying anyway.  Benefits outweigh the risks.

 And don't tell me it's not financially driven.  There is nothing in medical care not financially driven, when it comes to "new" recommendations--either from the HHS (who sponsors the group who came up with these findings, BTW, and they are not some altruistic group of doctors who actually take of patients----most manage large groups of medical care providers and their first thought is COST)  Or if it's some insurance employee or some of our "caring" politicos. 

Anxiety, hell, let's stop testing for prostate cancer, I can testify to the anxiety a positive PSA causes a man.  That should not even have been a consideration.

I do believe we need better testing.  but until then, don't quit mammos.  And don't give me that stuff about rads.  I get more working in my garden and I do that every year, too.

So---don't blow smoke up my skirt, I'm not buying the canned response you have offered along with others.  It's one of those : don't pee on my leg and tell me it's raining.

Those folks thought the population was too dumb to recognize when it's being screwed, but I have to tell ya: I think we know the difference in being kissed and being screwed.  Same goes for "gotta get the health care bill by Christmas".  No---not with all that pork and the secret meetings and payoffs.  Nope.

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