NBC's Andrea Mitchell and Rep. Debbie Wasserman Schultz, herself a breast cancer survivor, talk above about one of the biggest concerns sparked by the new guidelines: that insurance companies will now choose not to cover mammograms for women under 50. Doctors say this won't happen immediately, but is certainly possible, and the National Committee for Quality Assurance is already changing its system for grading health plans to reflect the new recommendations. Because of this, many worry that the change is motivated by a desire for cost-cutting, and not a concern for women's health. Carol H. Lee of the American College of Radiology says,
The only conclusion I can come to is it's economically motivated. In this climate, when we are all paying attention to how we can decrease the cost of health care, in my opinion that's the primary motivation.
But the United States Preventive Services Task Force, which not only recommended the change in mammogram ages but also said breast self exams have little benefit, says the real issue is unnecessary screening and even treatment. Women in their 40s are 60% more likely to experience false positives from mammograms, leading to unnecessary follow-up tests and anxiety. While these risks may seem relatively minor, early screening also increases the odds that a woman will be treated for cancer that never would have sickened her — and unnecessary cancer treatment is a much more serious proposition than a biopsy. Some women, in fact, seem relieved by the new guidelines. 51-year-old Nancy Moylan told the New York Times,
Sure, I know plenty of women who have breast cancer. And I know many, many women who've received false-positives. It always struck me that most women seemed so relieved to know that they don't have cancer that they never took the next step and said, ‘Hey, why was I just put through that anxiety? I've had all these invasive tests and worry only to find out that the mammogram isn't all it's cracked up to be?'
What's frustrating for many women may be the uncertainty of breast cancer screening, uncertainty only further compounded by the new guidelines, which have already been criticized by the American Cancer Society. Liesl Schillinger writes in The Daily Beast,
The only consistent message from the scientific community to women is to be afraid. How can issues of such life-and-death importance to women-more than half the population-be so murkily understood, and so conflictingly explained? Are medical authorities playing a guessing game with women's health?
Unfortunately, when it comes to breast cancer, a guessing game still seems to be the only game in town. Dr. Donald A. Berry, a statistician on the task force, says the money spent on regular mammograms for women under 50 "was buying something of net negative value," and that with the new guidelines, "the economy benefits, but women are the major beneficiaries." And in fact, many women have long forgone mammograms because they personally feel the risks outweigh the benefits. Unfortunately, mammograms only reduce the breast cancer death rate by 15% — a big deal if you are one of the ones saved, but still a relatively small fraction of all sufferers. This statistic — and the high number of false positives associated with mammograms — shows that what women really need are better screening tools. But for now, we have to decide what to do with the tools we have, and this decision has just become a lot more complicated.
Mammograms And Politics: Task force Stirs Up A Tempest [Washington Post]
Many Doctors To Stay Course On Breast Exams For Now [NYT]
New Mammogram Advice Finds A Skeptical Audience [NYT]
Panel Urges Mammograms At 50, Not 40 [NYT]
The Great Mammogram Debate [Daily Beast]