Ignore new mammogram guidelines

November 17, 2009

Poll: 76% women disagree with guidelines

Secy Sebelius statement
Secy Sebelius & Ann Curry (video)

Updated x 3

How can any woman take seriously recommendations that include stopping breast self-exams?

• Breast cancer is the number one cancer (excluding skin cancer) in women
• Number two cause of cancer death (behind lung cancer)
• 1 in 8 women will be diagnosed with breast cancer in their lifetime
• 1 in 35 chance that it will be the cause of death
• 15% women 40-49 detect breast cancer through mammography

2009 estimates
192,370 women will be diagnosed
40,170 women will die

By age:

• 30 – 39: 1 in 233
• 40 – 49: 1 in 69
• 50 – 59: 1 in 38
• 60 – 69: 1 in 27

15% of women in their 40s detect breast cancer through mammography.

There are approximately 2.5 million breast cancer survivors in the US.

Current mammogram recommendations:

American Medical Association: Age 40, every year
American Cancer Society: Age 40, every year
National Cancer Institute: Age 40 – every 1-2 years

The US Preventive Services Task Force has just changed their mammogram recommendations.

Note: there are no breast cancer specialists (or any cancer specialists) on the task force and their recommendations are “made for asymptomatic populations” and are “not disease—or individual—specific”. (*More info on the task force below.)

2002: age 40, every year
2009: Only ages 50-74 – every two years
Over 75 – no data.
Ages 40-49 should talk with their doctors.

Recommendation = reduced services + no need to be covered by insurance.

Timely, isn’t it?

And if the recommendations are followed – how many women will be diagnosed in 2010 and how many will die in 2011?

They also recommended against breast self-exams:

Because the USPSTF found adequate evidence that teaching self-examination is not associated with a decrease in breast cancer mortality rates, the task force recommends against teaching breast self-examination (BSE).

Why would they recommend against something that costs nothing?

Because of the unnecessary cost of false positives generated by self exams.

No mammogram + no BSE = no lumps = no unnecessary biopsy = no insurance payments

USPSTF estimates mammography prevents:

• 1 death for every 1,904 women age 40-49
  1 death for every 1,339 women age 50-59
  1 death for every 377 women ages 60-69

2 to 4 of every 1,000 mammograms find cancer/

80% of biopsies will not find cancer.

Chief Medical Officer American Cancer Society’s DR OTIS BRAWLEY:

With its new recommendations, the [task force] is essentially telling women that mammography at age 40 to 49 saves lives – just not enough of them.

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*Info on USPSTF:

Department of Health and Human Services –> Agency for Healthcare Research and Quality –>US Preventive Services Task Force

Agency for Healthcare Research and Quality (AHRQ )

The health services research arm of HHS.

Health services research: how people get access to health care, how much it costs, and what happens to patients as a result of it..

Home to research centers that specialize in major areas:

• Quality improvement and patient safety.
• Outcomes and effectiveness of care.
• Clinical practice and technology assessment.

• Health care organization and delivery systems.
• Primary care (including preventive services).
• Health care costs and sources of payment.

• A major source of funding and technical assistance for health services research and research training at leading U.S. universities and other institutions.

• A science partner, working with the public and private sectors to build the knowledge base for what works—and does not work—in health and health care and to translate this knowledge into everyday practice and policymaking.

How AHQR helps people

US Preventive Services Task Force

USPSTF is an independent panel of experts in primary care and prevention that systematically reviews the evidence of effectiveness and develops recommendations for clinical preventive services [screening, counseling, and preventive medications].

MISSION:

1- Evaluate the benefits of individual services based on age, gender, and risk factors for disease;

2-Make recommendations about which preventive services should be incorporated routinely into primary medical care and for which populations;

3-Identify a research agenda for clinical preventive care.

Interesting associations.

FEDERAL PARTNERS:

Centers for Disease Control and Prevention (CDC), Department of Defense (DOD), Centers for Medicare and Medicaid Services (CMS), Department of Veterans Affairs (VA), Health Resources and Services Administration (HRSA), National Institutes of Health (NIH), U.S. Army Center for Health Promotion and Preventive Medicine, and the U.S. Food and Drug Administration (FDA).

MEMBERS:

Epidemiologist, Professor of Biomedical Informatic; Dean, College of Public Health, Professor, Community and Family Medicine; Director of the Division of General and Community Pediatrics; Director, Maternal-Fetal Medicine and Women’s Health Services Research; Medical Director, Preventive Care and Senior Investigator, Center for Health Studies, Group Health Cooperative; Medical Director and Chief Health Officer, HealthPartners (HMO); Professor, Department of Family and Community Medicine; Professor, Geriatrics and Adult Development, Medicine, Health Policy; Dean and Professor, School of Nursing, Associate Director, Center for Healthcare Policy and Research; Dean, College of Nursing & Healthcare Innovation; Associate Professor, Johns Hopkins School of Medicine and Bloomberg School of Public Health; Professor of Medicine, Health Management, and Economics, Professor, Department of Medicine, Minneapolis VA Medical Center.

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Sources:
CNN’s Danielle Dellorto
American Cancer Society
Cleveland.com