Skip mammograms, quit breast self-exams, and maybe lighten up on 'defensive medicine' while we're at it

All those mammograms, self-exams and dutiful attention to catching breast cancer at the very first sign? Forget it. Might even do more harm than good.

As summarized by Associated Press writers Stephanie Nano and Marilynn Machione late Monday,
Most women don’t need a mammogram in their 40s and should get one every two years starting at 50, a government task forcesaid Monday. It’s a major reversal that conflicts with the American Cancer Society‘s long-standing position.

Also, the task force said breast self-exams do no good and women shouldn’t be taught to do them.

For most of the past two decades, the cancer society has been recommending annual mammograms beginning at 40.

But the government panel of doctors and scientists concluded that getting screened for breast cancer so early and so often leads to too many false alarms and unneeded biopsies without substantially improving women’s odds of survival.

“The benefits are less and the harms are greater when screening starts in the 40s,” said Dr. Diana Petitti, vice chair of the panel.

The new guidelines were issued by the U.S. Preventive Services Task Force, whose stance influences coverage of screening tests by Medicare and many insurance companies.

But Susan Pisano, a spokeswoman for America’s Health Insurance Plans, an industry group, said insurance coverage isn’t likely to change because of the new guidelines. No changes are planned in Medicare coverage either, said Dori Salcido, spokeswoman for the Health and Human Services department.

Maybe, just maybe, a clearer look at breast cancer screening could be accompanied by a good look at a little of the other possibly unnecessary and extraordinarily pricey “defensive medicine” going on around the country. What a fine way that would be to hold down costs and save a lot of time and angst. In another recent article (November 5) published in the San Francisco Chronicle, Associated Press reporter Steve LeBlanc wrote of how the costs of “defensive medicine,” along with malpractice insurance and lawsuit awards, are adding significantly to the soaring costs of health care.

LeBlanc illustrates the issue with a story that rings sadly true:

Dr. James Wang says he tries to tell his patients when medical procedures aren’t necessary. If they insist, though, he will do it – not so much to protect their health as his own practice.

After being sued for allegedly failing to diagnose a case of appendicitis, Wang says he turned to what’s known as “defensive medicine,” ordering extra tests, scans, consultations and even hospitalization to protect against malpractice suits.

“You are thinking about what can I do to prevent this from happening again,” he said, adding that he did nothing wrong but agreed to a minor settlement to avoid a trial.

We have, LeBlanc explains, doctors battling malpractice premiums and lawyers saying malpractice suits discourage bad medicine — meanwhile, the costs of it all add up to some ten percent of health care expenditures.

We the public, healthy and sickly alike, are caught in the middle. Could we not somehow declare a truce? We’ll quit rushing to sue, lawyers back off from chasing ambulances, doctors go about the business of practicing medicine according to patient need rather than fear of consequences. Seems like a good idea to me, but I’m not holding my breath.

I’m also not having any more mammograms any time soon.

New advice: Skip mammograms in 40s, start at 50 – Yahoo! News.

3 responses

  1. Your larger point is taken…but for those of us with a history of breast cancer in the family, it’s no laughing matter. I had my baseline mammo at 35 because my mom had a mastectomy and is, 13 years later, fine. It haunts many women and it’s the rare person who’ll shrug off any test they think might save their life.

    • You’re right, and of course my breast cancer was caught early… by a mammogram. I’m not saying quit them, I’m just saying slow down a little, especially for older women like me.

  2. The outcry over this study shows that Americans will not agree to tolerate one person being overlooked for a disease by not doing every possible test. Doctors have known this for some time which is why in all the risk management courses they take they are being warned to do any and all tests that a defense attorney could point to at trial and say “doctor if you had ordered this one simple test would you not have spared the patient having to face this disease?”
    Americans will bankrupt the system before they buy into the argument that if we do away with “unnecessary” tests we are certain to cause some patients to face a disease the test may have prevented. We will be forced to ration care at some time, but doctors will not stop ordering tests as long as malpractice attorneys are circling overhead waiting for some doctor to not prescribe a test that might show something.

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