So NOW guidelines change?

It was rather stunning to see the new mammogram recommendations roll out today, out of nowhere. And some press treat it as another ‘let’s get the FAQs’ feature (before people have time to absorb the blow to established norms and even form their questions).

Q: Which screenings are recommended?

No, first question should be ‘Why do we suddenly have new recommendations for screenings after all these years?’

But back to the talking points….

A: The U.S. Preventive Services Task Force recommends
mammograms for women 50 to 74 every other year. It says women and their
doctors should discuss the benefits and risks of mammograms beginning
at age 40. The findings don’t apply to high-risk patients, such as
those with a family history of breast cancer.

So now the question should be….’Who is the U.S. Preventive Services
Task Force, and why have they changed the established norms?’

But they don’t get to that question until the end of the piece. Just after this little item:

Q: Will the recommendations change insurance coverage?

A: Maybe…Medicare’s mammogram coverage can be changed in one of two
ways: Congress could pass a new law, or the secretary of Health and
Human Services could change coverage, after consulting the head of the
National Cancer Institute.

Aha. What this is really all about.

Q: What is the U.S. Preventive Services Task Force?

A: It’s an independent panel of government-appointed experts that
reviews medical research and recommends ways to reduce the risk of
illness and death. Although it’s sponsored and funded by the Agency for
Healthcare Quality and Research, part of the Department of Health and
Human Services, doctors are not obligated to follow its
recommendations. Its influence is con- siderable, however. The American
Academy of Family Physicians has endorsed the panel’s recommendations
on breast screening in the past.

And then there are those who are skeptical. Which some media responsibly reported, after such a big and controversial announcement.

Cancer experts fear new U.S. breast imaging guidelines
that recommend against routine screening mammograms for women in their
40s may have their roots in the current drive in Washington to reform

Critics of the guidelines, issued on Monday by the U.S. Services
Task Force, an independent panel sponsored by the U.S. Agency for
Healthcare Quality, say the new guidelines are a step backward and will
lead to more cancer deaths.

Here are some of their concerns.

* Dr Carol Lee, chairwoman of the American College of Radiology
Breast Imaging Commission, said she fears insurers — both private and
public — will use them to pare back health costs.

“These new recommendations seem to reflect a conscious decision to ration care,” Lee said in a statement.

She said since the onset of regular mammogram screening in 1990, the
death rate from breast cancer, which had been unchanged for the
preceding 50 years, has decreased by 30 percent.

* Dr Len Lichtenfeld, deputy chief medical officer of the American
Cancer Society, said the influential group will not change
recommendations for routine mammograms for women starting at age 40.

But he is worried that women will become so confused by the
conflicting recommendations they will stop getting mammograms
altogether. “Frankly, from our point of view that would be the worst
possible outcome,” Lichtenfeld said in a telephone interview.

* Lichtenfeld and other doctors are worried that insurance companies
and government insurers will seize on the recommendations as a way to
control rising health costs.

“What is going to happen is insurers are going to say, ‘The U.S.
Preventive Services Task Force doesn’t support screening. We’re not
going to pay for it,’” said Dr Daniel Kopans, professor of radiology at
Harvard Medical School and a senior radiologist at Massachusetts
General Hospital in Boston.

“There were no new data to assess. One has to wonder why these new
guidelines are being promulgated at a time when healthcare is under
discussion and I am afraid their decision is related to saving money
rather than saving lives,” Kopans said.

There you have it. Signs of things to come.

Speaking of NOW, where are the women’s organizations in all this?


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