The news today is full of reports about newly released mammogram guidelines for women. The U.S. Preventive Services Task Force is suggesting that women begin annual mammograms at age 50 instead of age 40, the standard for decades. The American Cancer Society disputes the recommendation and defends the existing standards.
Personally, I think the change is a dangerous mistake with suspicious timing. Health insurance companies are already under fire for their practice of paying out as little as possible as late as possible. A recommendation like this could be all the justification they need to stop paying for screening procedures for women younger than age 50.
I understand the rationale behind the new recommendation: Early screenings ($$$) produce a lot of false positives and those, in turn, may result in additional, unnecessary tests ($$$). Personally, I’d prefer a false positive to a malignancy diagnosed too late. And, given the moderate rate at which most malignancies develop, I feel confident that an annual physical exam and mammogram will detect a malignancy before it becomes dangerous.
It’s up to your doctor to recommend mammograms based on a careful evaluation of your medical history and risk. And it’s then up to you to decide what you want to do. However, there should be no question at all that if your doctor recommends it, your insurance company will pay for it — no matter how old or young you happen to be.
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The LA Times published a comprehensive report here.
“There should be no question at all that if your doctor recommends it, your insurance company will pay for it — no matter how old or young you happen to be.” That goes without saying, but I’m glad you said it anyway.
It’s not so much that the false positives result in more tests. It’s that a lot of them also result in unnecessary procedures. You know I’m a vocal critic of the recommendations that all women should have mammograms at 40. High risk? Sure. Bad genotype? Sure. Low-risk? I’m sorry, but no. FAR too many doctors are FAR too scalpel-happy. And of course, a lot of them are male who would probably pitch a fit if you told them one of their balls had to come off.
What’s more, by the time a malignancy is discovered in a woman in her 40s, it’s invariably too late. Younger women tend to develop the most aggressive kind of breast cancer. That’s why the task force said what it did: It’s just not all that beneficial to women in their 40s.
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I should amend the post to say “tests and procedures,” which is what I meant. Those tests and procedures (ultrasound, biopsy, etc.) either confirm the presence of a malignancy so that treatment can begin, or prove there is no malignancy. Only in hindsight, and only if nothing dangerous is found, can the procedures be called unnecessary. If cancer is found, then the procedure will have been potentially lifesaving.
Let me be clear here. I consider lumpectomies and mastectomies to be aggressive surgical treatment, not diagnostic procedures. They are not something any woman should to submit to without prior confirmation of malignancy from a pathology lab (or two) and a valid second opinion.
I’m a “better safe than sorry” kind of person when it comes to screening for potentially lethal disease processes. Statistically, the screenings may not turn up that many cancers in 40-something women, but if they found my cancer, I wouldn’t give a damn about the statistics.