Great news ladies! Women under 50 not at risk anymore!

Jeanne S. Mandelblatt, MD, MPH, of Georgetown Lombardi Comprehensive Cancer Center led the research team that developed the model.

The team concluded that mammogram screening every two years achieves most of the benefits of annual screening with far fewer false-positives and other negative outcomes.

"Mammogram screening clearly has benefits, but there are potential risks as well," she tells WebMD. "Women need to discuss their own individual balance of risks and benefits with their health care providers."

wolf;609294 wrote:

They're just trying to cull the herd to pave the way for Obamacare. Can't cover too many people now, can we?

Pie;609290 wrote:

Carry on.

Shawnee123;609274 wrote:

Goddammit, what's the suggested age level for Viagra?

:mad:

jujuwwhite;609467 wrote:

Well I'm so glad to know that I even though I'm 41 with an extensive family history of breast cancer, that I can STOP preparing for my yearly mammograms by slamming my breast in the door of the refrigerator and then pressing on it as I tell myself, "honey it will be over soon!!"

lumberjim;609392 wrote:

this thread has extra estrogen

The American Cancer Society continues to recommend annual screening using mammography and clinical breast examination for all women beginning at age 40. Our experts make this recommendation having reviewed virtually all the same data reviewed by the USPSTF, but also additional data that the USPSTF did not consider. When recommendations are based on judgments about the balance of risks and benefits, reasonable experts can look at the same data and reach different conclusions.

Task force vice-chairwoman Diana B. Petitti, MD, MPH, says the new recommendations do not mean average-risk women younger than 50 and older than 74 should never be screened.

Rather, they are meant to foster discussion between these women and their doctors about the risks vs. benefits of routine screening.

Potential risks include anxiety, unnecessary biopsy, and unnecessary treatment of cancers that would never become life threatening.

Cicero;609649 wrote:

"unnecessary treatment of cancers that would never become life threatening"

A little cancer never hurt right? Hey what doesn't kill me makes me stronger...Cancer is irrelevant unless it is fatal? oooh kay then.

monster;609711 wrote:

Some tumors grow so slowly they have no effect on their host. So yes, some cancer tumors are irrelevant.

TheMercenary;609712 wrote:

Esp if you are 75 years or older, or so the government wants you to think. Because you know after the age of 75....

monster;609714 wrote:

If I'm 75 and have a tumor that won't kill me in the next 25 years, I'll take the no treatment route. It has nothing to do with the government.

TheMercenary;609716 wrote:

And if you think that the government should be telling you to ignore it and it kills you in 2 years and you never see you great grand children because you ignored it how do you justify it to your family?

To bad so sad?

TheMercenary;609716 wrote:

And if you think that the government should be telling you to ignore it and it kills you in 2 years and you never see you great grand children because you ignored it how do you justify it to your family?

To bad so sad?

Sebelius tries to debunk this right away: The U.S. Preventive Task Force is an outside independent panel of doctors and scientists who make recommendations. They do not set federal policy and they don't determine what services are covered by the federal government. ... Indeed, I would be very surprised if any private insurance company changed its mammography coverage decisions as a result of this action.

The Obama administration says its mammogram policy is unchanged despite a U.S. panel's finding that routine tests aren't necessary for women in their 40s.

classicman;609846 wrote:

I'm gonna make a guess here that the issue may be who is going to pay for what if you decide to get screened, have a mammo or surgery. I have no idea of the answer at this point, but thats what I was reading into his posts.

Spexxvet;609854 wrote:

Or maybe "the government" will ignore the "recommendation". [COLOR="Red"]Oh look, they have[/COLOR].
Yeah Democrats!

glatt;609857 wrote:

So scientists are recommending something based on studies and numbers and stuff, and the politicians think it's political suicide to implement the changes recommended by the scientists. So they are simply ignoring the science. There ought to be a thread for posting examples of this sort of perverting of science for politics.

wrote:

Robert Smith, director of cancer screening for the American Cancer Society, says his organization also is sticking with the current guidelines "because we not only looked at the evidence that the task force looked at, but we also looked at newer, modern data."

Smith says a good part of the current disconnect is due to the rules of evidence used by the U.S. Preventive Services Task Force. It's a rigorous system that values above all else the "gold standard" of large randomized trials of screening tests such as mammography.

That's all well and good, he says, but mammography screening has reached the point where these expensive trials are vanishingly rare — if not practically and ethically impossible.

Smith cites a very recent study from Sweden, where mammography has a long history and record-keeping is meticulous. It's not a randomized trial of mammography, but instead compares breast cancers diagnosed in different time periods among women who were screened for cancer with mammograms and women who weren't. "It includes hundreds of thousands of women examined over many, many years," he says.

Breast cancer deaths declined 19 percent over time among women who didn't get regular mammograms. But women who did get screening mammograms had a 48 percent reduction in breast cancer mortality.

That's very different from the U.S. task force's estimate. It says the evidence indicates that mammograms reduce breast cancer deaths by 15 percent among women ages 40 to 49.

glatt;609857 wrote:

So scientists are recommending something based on studies and numbers and stuff, and the politicians think it's political suicide to implement the changes recommended by the scientists. So they are simply ignoring the science. There ought to be a thread for posting examples of this sort of perverting of science for politics.

Redux;609882 wrote:

In any case and in terms of government policies and recommendations, the HHS secretary made it clear that the currently accepted standards will prevail on this issue.

TheMercenary;609888 wrote:

As glatt stated. To protect her ass and the ass of the Obama administration.

TheMercenary;609899 wrote:

IMHO they should have just supported the findings and gone with it.

Sebelius's statement challenged the recommendations of that influential panel, the U.S. Preventive Services Task Force, made up of independent experts assembled by her department to address one of the most explosive issues in women's health.

jujuwwhite;609893 wrote:

If only 1 life is saved, it is well worth it.

glatt;609911 wrote:

For some reason, fighting breast cancer is super popular. It's a good thing for sure, but it's not rational that it's at the expense of everything else. The number one cause of death for women is coronary heart disease. Twice as many women in the United States die of cardiovascular diseases as from all forms of cancer, including breast cancer. Why aren't women all up in arms over the fact that you don't get annual stress tests? Your heart is much more important. How much plaque is built up in your arteries? Have you ever had any kind of test to tell you that? Since you're most likely to die of that, don't you think it's important?

Sundae Girl;609886 wrote:

I would be able to request testing from the age of 40 due to family circumstances ....... I probably won't though.

glatt;609911 wrote:

Why aren't women all up in arms over the fact that you don't get annual stress tests?

Minx;610024 wrote:

Must admit that I have not read the entire Thread, but , has anyone noted that the origina lLink doesn't work? Comes up with an Error Message.

Shawnee123;610056 wrote:

And while you're at it, let's cut down on pap smears as well, k?

http://www.cnn.com/2009/HEALTH/11/20/pap.cervical.cancer/index.html

wolf;610149 wrote:

My friend, the breast cancer surgeon, was talking about this yesterday. She said she had been researching the members of the U.S. Preventive Services Task Force, and that while they are doctors, they aren't cancer doctors ... family medicine, pediatrics, specialists in medical informatics and medical economics, but interestingly, not cancer.

Just looking over the list, not a lot of them appear to be in active practice, either ... researchers, university posts, that kind of thing.

TheMercenary;610166 wrote:

And that is the problem with most government panels which try to recommend how the government should manage your healthcare.

Redux;610168 wrote:

It is not the role of the Preventive Serivces Task Force studies to determine or even recommend how the government should manager your healthcare.

The role is to conduct research on the "effectiveness of a broad range of clinical preventive services"....to expand the knowledge base for practitioners and patients.

TheMercenary;610169 wrote:

As per our discussion yesterday, the facts prove out that this is not what happens.

wolf;610149 wrote:

My friend, the breast cancer surgeon, was talking about this yesterday. She said she had been researching the members of the U.S. Preventive Services Task Force, and that while they are doctors, they aren't cancer doctors ... family medicine, pediatrics, specialists in medical informatics and medical economics, but interestingly, not cancer.

Just looking over the list, not a lot of them appear to be in active practice, either ... researchers, university posts, that kind of thing.

Redux;610171 wrote:

Absolutely, you were wrong yesterday.

This latest study, which was funded and began under the Bush administration, did not make policy recommendations for government-administered health programs like Medicare, Medicaid, SCHIP....that was not, nor has it ever been, the intent of PSTF research.

It offers a perspective for physicians and patients.

TheMercenary;610174 wrote:

No, I am in this business and this is not what happens in the end. I deal with it every day.

Care is dictated by Medicare by paying or not paying for procedures in specific locations, costs, who can get care and who cannot get care is controlled by Medicare and Medicaid.

Intent is specifically different.

President Barack Obama deflects criticism that his health-care plan will bring on government rationing of medical care by arguing that insurance companies ration care. Everyone knows private payers limit access to some health care. But government does it in far more byzantine and arbitrary ways.

OLYMPIA, Wash. — When it's judging the value of medical treatments it pays for, Washington state imposes a tough standard, the kind that might save tens of billions of dollars a year if it were applied nationally.

A panel of medical professionals compares the effectiveness and safety of new treatments and tests with standard alternatives, typically choosing the least costly if there's no real difference. The panel's decisions don't apply to private health plans, but they're binding on 750,000 residents: state employees; people insured by Medicaid, the state-federal program for the poor; and those who are receiving workers' compensation.

The program is unique in the United States, and experts sometimes cite it as a possible model for the federal government. Studies suggest that using this approach would help eliminate inappropriate and wasteful care.

Critics, however, say it interferes with patient-physician decision-making and is a dangerous step down the road to what they consider rationed care, and it appears highly unlikely to gain support in Washington, D.C.

TheMercenary;610178 wrote:

Further, Medicare and Medicaid will pay $15,000 for a patient of theirs to have a surgery done in a major hospital down the street but will not pay $8000 for the same procedure in a surgery center. It happens every day in the US.

http://online.wsj.com/article/SB10001424052970204488304574435464052451436.html

TheMercenary;610166 wrote:

And that is the problem with most government panels which try to recommend how the government should manage your healthcare.

Spexxvet;610203 wrote:

How do they compare to profit-motivated insurance company panels which try to recommend how the insurance companies should manage your healthcare.

Why not?

wrote:

WASHINGTON – The former director of the National Institutes of Health is advising women to ignore new guidelines that delay the start of routine mammogram testing for breast cancer.
Dr. Bernadine Healy says the directive would save money but not lives.

The recommendation, released last week by an independent panel, recommends that women not routinely undergo mammograms until age 50. Longtime guidelines have said women should have regular mammogram screening after age 40.
Healy says that if the new guidelines are followed, more women will die.

Sundae Girl;610418 wrote:

Because the stats are against it happening.
Cousin Susan got breast cancer at 49, but Mum and Nan were in their 60s.
My GP thinks I'm having migraines because my weight means I have slightly higher than normal blood pressure. I'm more worried about that.

Also, I do check myself regularly.

If I'm going to cost the NHS money, I'd rather it was for something I was really at risk from. Sadly, of course I don't get to choose - Bucks have just cancelled funding of a counselling centre for example - nice. Right now I need that more than I need to squeeze my tit into a machine.

The New York Times
December 13, 2009
The Way We Live Now

[SIZE=4]Mammogram Math
[/SIZE]By JOHN ALLEN PAULOS

In his inaugural address, Barack Obama promised to restore science to its “rightful place.” This has partly occurred, as evidenced by this month’s release of 13 new human embryonic stem-cell lines. The recent brouhaha over the guidelines put forth by the government task force on breast-cancer screening, however, illustrates how tricky it can be to deliver on this promise. One big reason is that people may not like or even understand what scientists say, especially when what they say is complex, counterintuitive or ambiguous.
As we now know, the panel of scientists advised that routine screening for asymptomatic women in their 40s was not warranted and that mammograms for women 50 or over should be given biennially rather than annually. The response was furious. Fortunately, both the panel’s concerns and the public’s reaction to its recommendations may be better understood by delving into the murky area between mathematics and psychology.
Much of our discomfort with the panel’s findings stems from a basic intuition: since earlier and more frequent screening increases the likelihood of detecting a possibly fatal cancer, it is always desirable. But is this really so? Consider the technique mathematicians call a reductio ad absurdum, taking a statement to an extreme in order to refute it. Applying it to the contention that more screening is always better leads us to note that if screening catches the breast cancers of some asymptomatic women in their 40s, then it would also catch those of some asymptomatic women in their 30s. But why stop there? Why not monthly mammograms beginning at age 15?
The answer, of course, is that they would cause more harm than good. Alas, it’s not easy to weigh the dangers of breast cancer against the cumulative effects of radiation from dozens of mammograms, the invasiveness of biopsies (some of them minor operations) and the aggressive and debilitating treatment of slow-growing tumors that would never prove fatal.
The exact weight the panel gave to these considerations is unclear, but one factor that was clearly relevant was the problem of frequent false positives when testing for a relatively rare condition. A little vignette with made-up numbers may shed some light. Assume there is a screening test for a certain cancer that is 95 percent accurate; that is, if someone has the cancer, the test will be positive 95 percent of the time. Let’s also assume that if someone doesn’t have the cancer, the test will be positive just 1 percent of the time. Assume further that 0.5 percent — one out of 200 people — actually have this type of cancer. Now imagine that you’ve taken the test and that your doctor somberly intones that you’ve tested positive. Does this mean you’re likely to have the cancer? Surprisingly, the answer is no.
To see why, let’s suppose 100,000 screenings for this cancer are conducted. Of these, how many are positive? On average, 500 of these 100,000 people (0.5 percent of 100,000) will have cancer, and so, since 95 percent of these 500 people will test positive, we will have, on average, 475 positive tests (.95 x 500). Of the 99,500 people without cancer, 1 percent will test positive for a total of 995 false-positive tests (.01 x 99,500 = 995). Thus of the total of 1,470 positive tests (995 + 475 = 1,470), most of them (995) will be false positives, and so the probability of having this cancer given that you tested positive for it is only 475/1,470, or about 32 percent! This is to be contrasted with the probability that you will test positive given that you have the cancer, which by assumption is 95 percent.
The arithmetic may be trivial, but the answer is decidedly counterintuitive and hence easy to reject or ignore. Most people don’t naturally think probabilistically, nor do they respond appropriately to very large or very small numbers. For many, the only probability values they know are “50-50” and “one in a million.” Whatever the probabilities associated with a medical test, the fact remains that there will commonly be a high percentage of false positives when screening for rare conditions. Moreover, these false positives will receive further treatments, a good percentage of which will have harmful consequences. This is especially likely with repeated testing over decades.
Another concern is measurement. Since we calculate the length of survival from the time of diagnosis, ever more sensitive screening starts the clock ticking sooner. As a result, survival times can appear to be longer even if the earlier diagnosis has no real effect on survival.
Cognitive biases also make it difficult to see the competing desiderata the panel was charged with balancing. One such bias is the availability heuristic, the tendency to estimate the frequency of a phenomenon by how easily it comes to mind. People can much more readily picture a friend dying of cancer than they can call up images of anonymous people suffering from the consequences of testing. Another bias is the anchoring effect, the tendency to be overly influenced by any initially proposed number. People quickly become anchored to such a number, whether it makes sense or not (“we use only 10 percent of our brains”), and they’re reluctant to abandon it. If accustomed to an annual mammography, they’re likely for that reason alone to resist biennial (or even semiannual) ones.
Whatever the role of these biases, the bottom line is that the new recommendations are evidence-based. This doesn’t mean other right-thinking people would necessarily come to the same judgments. To oppose the recommendations, however, requires facts and argument, not invective.

[SIZE=2]John Allen Paulos, professor of mathematics at Temple University, is the author most recently of “Irreligion.”
[/SIZE]

ZenGum;616848 wrote:

A similar survey found that nine out of every ten doctors think one out of every ten doctors is an idiot. :D