Health Reform Bill – Mammo Guidelines NOT “JUST Guidelines” –
Comments
-
nevermind -- decided to delete -- no point in pointing out the obvious.
-
Laura, that's not more recent data. Betsey McCaughey is quoting a paper published in the Lancet in 2007. I quoted a paper published in the Lancet in 2008. Can you direct me to the actual published research that Betsey McCaughey is citing, rather than just her commentary on it?
Thanks,
Ann
-
I agree 2tzus -- that's why I went back and deleted my comment. I'm in a mood today and should stay away from any sort of debate! Hugs,
Elizabeth
Edit to add: I do agree with KLFH and her posts.
-
So, you are trying to say that routine mammography over age 50 is a bad idea? Not making much sense there.
And for your second post, I'm not going to dignify with an answer, other than to say that you are totally out of line trying to make this personal.
-
But it is a partisan issue because this thread is making it a partisan issue.
-
Colette, just because a doctor or doctors said it would have been caught, it doesn't mean that it would have. I had dense breast tissue and a large tumor. It was not caught in 3 or 4 mammograms.
-
Thank you Elizabeth. I agree that it shouldn't be about politics. The fact is EVERYTHING seems to be about politics nowadays and I am disturbed that so many people are reacting to this with a knee jerk reaction instead of looking at what is actually be said and written.
-
2tzus wrote:
klfh, you are the one making this partisan, from your remarks in the fox news thread and this one. It's obvious where you are coming from. I'll delete the other remark, but if you don't want your personal political viewpoints known, you shouldn't blog about them on the internet.Well, it should be up to me to bring that up then, shouldn't it? Shouldn't we be discussing what is going on here, not something that I may or may not have written in a blog a year ago? That's more than just a tad stalker-ish.
-
"Under the Democratic plan, a new independent institute would advise the health secretary. However, the health secretary would not be required to deny or extend coverage in a government-backed health plan based on recommendations from the institute."
Sadly, what you seem to be missing is the big picture here. Mammograms are NOT the answer. They miss cancers in young women. We should be focusing on PREVENTION and CURE and BETTER DETECTION METHODS.
And as far as the political thing, my very public political POV had nothing to do with this debate. I am seeing right wingers exploiting this study and trying to incite fear and simply commented on that.
-
I so agree with the desire to deal calmly and reasonably with the matter at hand, and I agree that emotional or knee-jerk reactions (for example, the View co-host stating it's "female genocide") not only don't serve any useful purpose, they actually detract from the issue at hand.
I also agree that the guidelines for mammogram screening (or anything of a similar medical nature for that matter) should be determined by medical experts evaluating the effectiveness Vs risk, separate from any political agenda. Unfortunately (and not to be negative Nancy), I'm just not sure that's viable in today's society.
I have much more respect for the one panel member I heard on a radio interview who stated (in a more direct/honest in my opinion way) that the lives extended or saved in the 40-49 group were not deemed to be worth the risk from a "cost" perspective, particularly as the women in this age group typically have cancer that doesn't respond to treatment. In other words, finding their cancer doesn't save their life, it just extends the inevitable (but not by much) and cost money in the process. Doesn't change anything I know, but it was just less insulting for me to not have people pretend that the risk of undue stress from a false positive was a legimate reason.
What's hard for me is that I am that one life. I am that woman with aggressive cancer for whom treatment has extended my life for almost 5 years now. There is a little part of me that is even starting to believe it flat out worked, and that mets/recurrence are not in my future.
Strangely, this whole discussion has brought to light these weird feelings of survivor guilt for me. Why am I the "lucky" one who did respond to treatment for my cancer, when so many of my friends here with similar dx did not? Talk about stress! :-)
Bottom line, even though my situation makes the topic a very emotional one for me, I believe that a discussion of the facts is critical to the solution. An honest, transparent discussion.
Edited to add: Crap! Wrong thread! Meant to put it on "Critical Thinking, Not Fear Based" Sorry ladies. I will try to figure out how to copy/paste to that thread.
-
Stalker-ish, definitely stalker-ish.
No, saving money is not MY motivation. Trying to make people understand that mammograms are not the panacea that many want to believe. I prefer to side with science, not what I think people are trying to say on an anonymous message board.
With that, I'm done. There is clearly no reasonable set of facts that will influence you. You'll dismiss what doesn't fit your point of view (such as, ignore Canada and Cuba's numbers) and try to make everything else personal. It's sad to me that you would go after me and my politics when I am advocating an end to breast cancer. Clearly you can't see beyond your own POV, so that's where it stops.
Best of luck. It's a sha
-
Sherri, neither the House nor the Senate bill has anything whatsoever to do with the availability of mammograms (except insofar as reducing the number of women without insurance will make mammograms MORE available). Period. It's very unfortunate that anyone on this board is frightening women by claiming otherwise.
The USPSTF guidelines discourage *routine* screening of women in their 40s. They encourage doctors and patients to discuss the risks and benefits and arrive at an individual decision. So, you would still be eligible for the mammogram that detected your cancer. It's possible, of course, that some women, hearing or reading about the new guidelines, will make the decision to forego an annual mammogram -- and for many, many women on this board, that's a frightening thought (I have a different perspective, but that's just me). But it's important to know that the guidelines don't make anyone "ineligible."
Linda
-
Well, there's hope down the road for us all on earlier detection. Please pardon a copy and paste from one of the threads, yet this shows there's value in those MRI's with mammograms and someday with more bioengineering tweaking, perhaps on their own. MRI's sensitivity and specificity exceeds mammograms.
Prevention, early detection, continued progress in treatment (copied another post too). I see good things ahead.
Cost-Effective Screening for Breast Cancer Worldwide: Current State and Future DirectionsMammographyMammography provides X-ray images of the breasts with at least two sets of images, the mediolateral oblique and cranial-caudal views. A recent large-scale clinical study (42,760 patients in U.S.A. and Canada) on the diagnostic performance of mammography for breast-cancer screening demonstrated a sensitivity of 70.0%, specificity of 92.0%, and diagnostic accuracy interpreted as AUC of 78.0%[4]. The European randomized mammography screening trial (23,929 patients in Norway) revealed a sensitivity of 77.4% and specificity of 96.5% at full-field digital mammography. The median size of screening-detected invasive cancers was about 13.5 mm[19]. In the United States, despite the recommendation for an annual mammogram, in 2005 only 47.8% of women aged 40–49 years had a mammogram within the past year. Among the women without health insurance coverage this value decreases to 24.1% [10]. The cost-effectiveness screening film mammography are estimated as 902–1,946 USD per year of life saved in India, 2,450–14,790 USD per year of life saved in Europe, and 28,600–47,900 USD per year of life saved in U.S.A.[6]. Among the limitations of mammography are increased breast density, technical factors, e.g. areas adjacent to the chest wall may not be imaged[20], lack of insurance coverage, disagreements among primary care physicians on frequency of mammographic screening, variation in interpretation skills of radiologists.The mean glandular radiation dose from 2-view mammography is approximately 4 to 5 mGy and the dosage varies among facilities and increases with breast density. The average cumulative exposure from screening during the decade will be around 60 mGy[70]. There is a strong linear trend of increasing risk of radiation-induced breast cancer with increasing radiation dose (P = 0.0001) [71]. A statistically significant increase in the incidence of breast cancer following radiation treatment of various benign breast diseases was observed[72]. Several recent studies suggesting that carriers of pathogenic alleles in DNA repair and damage recognition genes may have an increased risk of breast cancer following exposure to ionizing radiation, even at low doses[73]. Based on review of 117 studies related to screening mammography the authors concluded that “the risk for death due to breast cancer from the radiation exposure involved in mammography screening is small and is outweighed by a reduction in breast cancer mortality rates from early detection.”[74].MRIMRI utilizes magnetic fields to produce detailed cross-sectional images of the breast tissue. Image contrast between tissues in the breast (fat, glandular tissue, lesions, etc.) depends on the mobility and magnetic environment of the hydrogen atoms in water and fat that contribute to the measured signal that determines the brightness of tissues in the image. Many indications for clinical breast MRI are recognized, including resolving findings on mammography and staging of breast cancer[22]. Overall, the results of 6 nonrandomized prospective studies in the Netherlands[24], the United Kingdom[25], Canada[26], Germany[27], the United States[28], and Italy[29] of MRI efficacy in breast cancer screening for high risk women populations demonstrate an averaged sensitivity of 87.5% and specificity of 92.8%. Only limited data are available on the cost effectiveness of breast MRI screening being combined with mammography. The cost per quality-adjusted life year saved for annual MRI plus film mammography, compared with annual film mammography alone, varied by age and other factors to be found in the range of 27,544–130,420 USD. The reimbursement for bilateral MRI diagnostic procedures was 1,037 USD according to 2005 U.S. average Medicare reimbursements, which is about eight times higher than the screening mammography[5] and out of pocket charges by private clinics are as much as 5 times higher.American Cancer Society Guidelines for Breast Screening with MRI as an Adjunct to Mammography
CA Cancer J Clin 2007; 57:75-89
<font>Limitations of Evidence from MRI Studies and Research Needs</font>"Although the literature shows very good evidence for greatersensitivity of MRI than mammography and good evidence for astage shift toward earlier, more favorable tumor stages by MRIin defined groups of women at increased risk, there are stillno data on recurrence or survival rates, and therefore, lead-timebias is still a concern. Further, a large randomized, mortalityendpoint study is unlikely to take place, and it will be necessaryin the foreseeable future to rely on evidence of stage of diseaseand types of cancers. In the absence of randomized trials, recurrenceand survival data will come from observational study designs."CONCLUSIONSelect Paragraph (1 of 3): "Several studies have demonstrated the ability of MRI screeningto detect cancer with early-stage tumors that are associatedwith better outcomes. While survival or mortality data are notavailable, MRI has higher sensitivity and finds smaller tumors,compared with mammography, and the types of cancers found withMRI are the types that contribute to reduced mortality. It isreasonable to extrapolate that detection of noninvasive (DCIS)and small invasive cancers will lead to mortality benefit."ANDTenderIsOurMight wrote:Since my original diagnosis in 2001:
a. Oncotype Dx, for node negative and most recently for node+ (1+,low grade or such): gene profiling your own tumor tissue for specifics unique to you so therapy can be personalized from results. Being aware of your ER/PR result and your Ki-67 numerical result with discussion with your treating oncologist.
b. Dose dense chemotherapy (q2 weeks yields better OS than q3 weeks)
c. Taxane family regimen: TAC rather than AC then T for improved DFS (T= docetaxol, also taxol and placitaxol
d. TC often replacing TAC or AC-T when cardiotoxicity of issue (answer still not complete)
e. Neoadjuvant chemotherapy to reduce disease and allow lumpectomy in select patients
f. Hormone therapy for ER/PR+ patients with low oncotype and some in gray zone per risk/benefit
g. Neoadjuvant hormonal therapy with gene analysis- ongoing research
h. Zometa IV for premenopausal women to help reduce metastasis (still unclear about postmenopausal women)
g. Nipple sparing mastectomy- with greatly modified surgical scar
h. SLN alone or with few fellow lymph nodes with return of negative pathologic findings on final exam- still under study but seems this may help reduce ALND.
i. PET/CT scan upon diagnosis in select cases to ensure correct staging
j. Mammogram, MRI combination with breast mass preoperatively for elucidation of extent of breast involvement.
k. Extension of hormonal therapy past 5 years in select cases (grade III, node positive)- still under study but also used at onocologist/patient discretion with informed consent
g. Verification that AI's are + associated with carpel tunnel syndrome, arthalgias, muscle and bone pain, partially through confirmation of tenosynovitis of joints on MRI. This was major confirmation of complaints of AI users not picked up in original ATAC trials.
h. Extension of Herceptin use past first year in certain cases; development of Tykerb,
g. Verification that even isolated cells in SNL/other strongly suggest treatment with chemotherapy or hormone therapy in small tumors
i. Introduction of kinase therapies: to attack cancer cell division through protein production modification
j. Consideration of checking one's Tamoxifen metabolizing ability prior to onset of treatment by submitting blood for CYPD6, with counseling about one's status as well as suggested co-drug advoidances- still contraversial but less so than years ago.
k. Triple negative disease: very chemotherapy sensitive, with new insight to the value of platinum drugs.
l. Oral carbecitabene (Xeloda), a second oral chemotherapy (cyclophosamide is also oral) which limits hair loss
k. More, but I've run out of steam, perhaps others might add to the list?
Looking back it seems light years ago since my treatment, given all the developments, for which I am very thankful for for my sisters and brothers.
Tender
PS: please feel free to copy and past and add on. You could even organize by subsections should someone wish. Best, Tender
-
Reading some of these posts has the feeling of being in flatland and watching people who just noticed the existence of "up" and think it's a new discovery.
This task force has been in place since 1984. Here is a link to all the recommendations they have made while most of us never knew they existed:
http://www.ahrq.gov/clinic/uspstf/uspstopics.htm
Government has been "involved" with health care for a LONG while... (Hence the existence of hthe NIH, FDA etc.)
It is so bizarre that folks who are against health care reform are the ones who are most enraged about this. The bill cited is meant to legislate the MINIMUM standards. You would still have your capatlistic right to buy better insurance if you can afford it. (The health care bill won't take that away, either. )If you trust business to give you good insurance, what do you care about "gummit" minimum standards?
On the other hand, if you are pro health reform, how many above 50 lives will be saved by government intervention?
You can't play both sides of the fence.
-
KLFH, you posted:
"...but right off the bat I can dispute your claim that it's non partisan."
You disputed my claim by referencing the following quote:
"If successful, Obama Care will create a terribly bureaucratic and dysfunctional health care system."
First of all...I cannot find that sentence ANYWHERE in the article featured in the link I supplied. Please post the link to the article that included the above sentence. Thanks!
The below sentence WAS included in the article featured in the link I supplied:
"Thus, the U.S. government should focus on ensuring that all cancer patients receive timely care, rather than radically overhauling the current system."
The above sentence is clearly non-partisan.
-
If you click the link in my post (the line that's in purple) it will take you to the source.
-
When our government - regardless of party - can prove that they can end the corruption, FRAUD, mis-management, little-management and no-management with our existing Medicare and Medicaid programs, then, and only then, will I feel they could possibly manage every citizen's health care.
Until they can clean it all up, they need to scrap the whole Death Care Reform Act.
If ANY private sector company did business the way our government has with Medicare and Medicaid...that private sector company would have been bankrupt within years. Instead of going bankrupt from years of mis-managment, they steal from the working tax payers and fuel the FRAUD.
If the DCRA goes through...the FRAUD will find it. And the government will once again, fuel the FRAUD with higher taxes.
Eliminate the FRAUD within Medicare and Medicaid and GUESS WHAT?...there might be enough money to offer Medicare and Medicaid to all those who cannot afford insurance. Afterall...isn't that what Medicare and Medicaid were originally created for?
And btw...are you all aware that if the DCRA goes through, atleast 218 (probably more) new government agencies will have to be created. And these agencies will have to employ thousands of people. And WHERE DO YOU THINK THE MONEY TO PAY THESE PEOPLE will come from?
TAXES, TAXES AND MORE TAXES. Or perhaps Michele planted a money tree in her White House garden that I haven't heard about.
It's the whole Robbin' the Hood theory...only in this fairytale, the rich/successful business owners, to avoid getting robbed, will set up shop overseas. They'll have the money to run - and then we'll be the ones bailing it out all out.
-
It says, "shall provide coverage for" and "shall not impose cost sharing for"
It does NOT say they cannot provide more than that. That's otherwise known as a minimum.
-
It says, "shall provide coverage for..services that have a rating of A or B" It DOES not say they cannot provide coverage for C or D. That's a minimum.
-
************
LauraGTO said:
"these agencies will have to employ thousands of people. And WHERE DO YOU THINK THE MONEY TO PAY THESE PEOPLE will come from?"
************
People employed by private insurance are paid, also, that passes on to consumers through premiums. (Plus insurance companies include outrageous CEO salaries and bonuses.)
When you like a policy, it's job creation. When you don't, the salaries are taxes
Health care has to be paid for, either way.
-
Well, if private business won't pay for anything that isn't legislated - then why are folks arguing that government shouldn't intervene in health care - because we have to FORCE insurance to pay, right?
If we have to pay with our taxes, then we want evidence that it's worthwhile, no?
-
Basically what you're saying is, we want everyone covered for everything, whether or not it's proven safe and/or effective, and we don't want to pay for it through either premiums or taxes -
and we don't want experts looking at studies to decide what works.
-
2tzus: minimum means minimum. If minimum means what will be paid for, then nothing would be paid for now, since the current minimum is zippo. (I'm talking about the U.S., of course. If the Canadians haven't all fled this thread in horror by now, they must surely be shaking their heads in puzzlement.)
If it makes you feel better, the requirements for "essential health benefits" that must be covered in policies sold through the insurance exchange are spelled out, in very general terms, elsewhere in the bill (subtitle D, starting on p. 100). You'll see that it's not very prescriptive - just a list of rather broad categories (e.g., hospitalization, outpatient services, maternity and newborn care, prescription drugs, etc. etc.) that are supposed to reflect the coverage available in a typical employer plan. Hardly the heavy hand of government dictating what shall and shall not be covered!.
I'm mystified at how an effort to establish minimum consumer protections at the national level (no annual or lifetime coverage maximums, no abusive rescissions of coverage, full coverage for recommended vaccinations and preventive care, etc. - all of which are in the section of the bill clipped at the start of this thread) could possibly be interpreted as a takeaway.
Linda
-
Private sector businesses bring in money the government only spends it. Private sector businesses grow and flourish. They down size if profits are low, they up size if profits are high. This is business 101. The government never down sizes...they just keep adding agencies and employees. They keep creating a bigger government. And as a result - they have a deficit of over 3 trillion dollars. Spend, spend, spend, tax, tax, tax.
---------------------------------------
I have never had to force my insurance to pay. I pay my deductible, they pay my medical bills.
You wrote:
"...and we don't want experts looking at studies to decide what works."
What so called "expert" would report/agree that BSE's are unnecessary. OMG - Help me!
-
***********
LauraGTO wrote: Private sector businesses bring in money the government only spends it.
**********'
So that who may benefit?
Your ideolgy is clear. Did you ever wonder who cares if you're covered, really, other than you? If you were not and croaked off tomorrow because of it, you'd be just another uninsured American statistic. You. No coverage. No tests, no treatment.
Personal greed.... OMG, help me.
-
I was dx by mammo 2 weeks after my 40th birthday. Don't you DARE tell me I wasn't worth it or it didn't save my life.
Konakat, on every thread you post, you pit left against right. This isn't about that. Open your eyes.
This thread is about the new guidelines. This thread is about how it is effecting insurance to no longer be required to pay for women under 50. Period. What is it some of you don't get? I don't understand how you get "oh insurance companies WILL pay for women under 50". Show me the Government paper that says that.
People, Read both HR3590 and the new guidelines again. Read the definition of A-B-C etc.. the links on the first page of this thread lead to GOVT sites, not opinion based blogs. You missed something. We can't reiterate anymore to help you understand.
-
and a couple of you... you know who you are... are just displaying a sharp tongue and waging personal attacks on members of this board without any intelligence behind it what so ever.
-
********
LittleC wrote: I was dx by mammo 2 weeks after my 40th birthday. Don't you DARE tell me I wasn't worth it or it didn't save my life.
*********
Who said that to you? I don't see it anywhere.
*********
LittleC wrote:
I don't understand how you get "oh insurance companies WILL pay for women under 50". Show me the Government paper that says that.
*********
"Government Papers"? There is a bill in the senate, A PROPOSED law that you may contact your legislator about....
It does not say that insurance may not pay.
Yes, it is very likely they will seize any reason they can to deny coverage and make profits. I agree. All the more reason why oversight is imperative.
-
pill - it's at the top of this thread. if you can't understand it, I can't help.
-
LittleC -- I only stated what I though above and deleted it within a few minutes. I really don't know what you're talking about. If I agree with someone, is it not OK to say so?
Categories
- All Categories
- 679 Advocacy and Fund-Raising
- 289 Advocacy
- 68 I've Donated to Breastcancer.org in honor of....
- Test
- 322 Walks, Runs and Fundraising Events for Breastcancer.org
- 5.6K Community Connections
- 282 Middle Age 40-60(ish) Years Old With Breast Cancer
- 53 Australians and New Zealanders Affected by Breast Cancer
- 208 Black Women or Men With Breast Cancer
- 684 Canadians Affected by Breast Cancer
- 1.5K Caring for Someone with Breast cancer
- 455 Caring for Someone with Stage IV or Mets
- 260 High Risk of Recurrence or Second Breast Cancer
- 22 International, Non-English Speakers With Breast Cancer
- 16 Latinas/Hispanics With Breast Cancer
- 189 LGBTQA+ With Breast Cancer
- 152 May Their Memory Live On
- 85 Member Matchup & Virtual Support Meetups
- 375 Members by Location
- 291 Older Than 60 Years Old With Breast Cancer
- 177 Singles With Breast Cancer
- 869 Young With Breast Cancer
- 50.4K Connecting With Others Who Have a Similar Diagnosis
- 204 Breast Cancer with Another Diagnosis or Comorbidity
- 4K DCIS (Ductal Carcinoma In Situ)
- 79 DCIS plus HER2-positive Microinvasion
- 529 Genetic Testing
- 2.2K HER2+ (Positive) Breast Cancer
- 1.5K IBC (Inflammatory Breast Cancer)
- 3.4K IDC (Invasive Ductal Carcinoma)
- 1.5K ILC (Invasive Lobular Carcinoma)
- 999 Just Diagnosed With a Recurrence or Metastasis
- 652 LCIS (Lobular Carcinoma In Situ)
- 193 Less Common Types of Breast Cancer
- 252 Male Breast Cancer
- 86 Mixed Type Breast Cancer
- 3.1K Not Diagnosed With a Recurrence or Metastases but Concerned
- 189 Palliative Therapy/Hospice Care
- 488 Second or Third Breast Cancer
- 1.2K Stage I Breast Cancer
- 313 Stage II Breast Cancer
- 3.8K Stage III Breast Cancer
- 2.5K Triple-Negative Breast Cancer
- 13.1K Day-to-Day Matters
- 132 All things COVID-19 or coronavirus
- 87 BCO Free-Cycle: Give or Trade Items Related to Breast Cancer
- 5.9K Clinical Trials, Research News, Podcasts, and Study Results
- 86 Coping with Holidays, Special Days and Anniversaries
- 828 Employment, Insurance, and Other Financial Issues
- 101 Family and Family Planning Matters
- Family Issues for Those Who Have Breast Cancer
- 26 Furry friends
- 1.8K Humor and Games
- 1.6K Mental Health: Because Cancer Doesn't Just Affect Your Breasts
- 706 Recipe Swap for Healthy Living
- 704 Recommend Your Resources
- 171 Sex & Relationship Matters
- 9 The Political Corner
- 874 Working on Your Fitness
- 4.5K Moving On & Finding Inspiration After Breast Cancer
- 394 Bonded by Breast Cancer
- 3.1K Life After Breast Cancer
- 806 Prayers and Spiritual Support
- 285 Who or What Inspires You?
- 28.7K Not Diagnosed But Concerned
- 1K Benign Breast Conditions
- 2.3K High Risk for Breast Cancer
- 18K Not Diagnosed But Worried
- 7.4K Waiting for Test Results
- 603 Site News and Announcements
- 560 Comments, Suggestions, Feature Requests
- 39 Mod Announcements, Breastcancer.org News, Blog Entries, Podcasts
- 4 Survey, Interview and Participant Requests: Need your Help!
- 61.9K Tests, Treatments & Side Effects
- 586 Alternative Medicine
- 255 Bone Health and Bone Loss
- 11.4K Breast Reconstruction
- 7.9K Chemotherapy - Before, During, and After
- 2.7K Complementary and Holistic Medicine and Treatment
- 775 Diagnosed and Waiting for Test Results
- 7.8K Hormonal Therapy - Before, During, and After
- 50 Immunotherapy - Before, During, and After
- 7.4K Just Diagnosed
- 1.4K Living Without Reconstruction After a Mastectomy
- 5.2K Lymphedema
- 3.6K Managing Side Effects of Breast Cancer and Its Treatment
- 591 Pain
- 3.9K Radiation Therapy - Before, During, and After
- 8.4K Surgery - Before, During, and After
- 109 Welcome to Breastcancer.org
- 98 Acknowledging and honoring our Community
- 11 Info & Resources for New Patients & Members From the Team