We need answers: Is early screening not saving lives? Why do doctors’ groups disagree? Did costs play any role in these decisions to change the recommendations on breast and cervical cancer screenings? We need assurances that everything we’ve heard this week about fewer tests for women’s cancers is a result of patient-focused research and providing the best care for the right reasons, and not because of bureaucratic pressure to control costs.
For clarification's sake, it should be noted that the American College of Obstetricians and Gynecologists that made the cervical cancer screening suggestions is a professional organization not a government-related panel. However, we must still ask the questions that the Governor is suggesting regarding new recommendations that have come out. We must make sure that the recommendations are based on "patient-focused research" and strong science.
To me, the recommendations that cause the greater concern are the mammography recommendations that came out earlier this week from the U.S. Preventative Services Task Force. This report states that women between the age of 40-49, who are not at increased risk for breast cancer, are no longer recommended to have mammograms. I found their reasoning to be a bit weak. The report states that beginning mammography for women at age reduces breast cancer mortality by 3%. However, the report cited that the net benefits of mammography for women aged 40-49 were "small", and they cited that potential harms of mammography were anxiety, false positives, and unnecessary biopsies. While I understand their concern with these potential harms, a reduction of cancer mortality of 3% seems sufficient to me for screening to be recommended. I've been doing some analysis at work recently on breast cancer in Illinois. Between 1996 and 2005, 915 Illinois women between the ages of 40-49 were diagnosed with breast cancer. If these recommendations were in place at the time, many of these women would likely have been diagnosed with breast cancer at a later stage.
To be fair, the Department of Health and Human Services is not supporting these recommendations. However, we still need to be aware of such reports. The U.S. Preventive Service Task Force, although independent, is funded by the U.S. government--a bureaucratic panel if you will.
The Disclaimer states on the report:
Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.
However, in the financial support section of the report it says, "[t]he U.S. Congress mandates that the Agency for Healthcare Research and Quality support the operations of the USPSTF."
This Congressionally funded task force set forth recommendations, that, for the time being at least, were not adopted by the Department of Health and Human Services. However, what if a government-centered health care passed, and they were looking for ways to cut costs? Could they potentially find support for a certain recommendation regardless of its true validity, adopt the recommendation, and subsequently drop insurance coverage for a certain procedure in order to cut costs? Also, as this task force is "independent" but overseen by the government,there is reason to be cautious in accepting what they say as there is potential for nefarious governmental influence.
I don't say this to be an alarmist or conspiracy theorist. We just must be cognizant of what the potentials are. At the same time, we have to look at such reports rationally ourselves to make sure they are based on strong science. Changes in recommendations and treatments do not necessarily mean rationing will occur. However, we must evaluate the information floating around out there, and we must be aware of the potential for interaction between such government-supported panels and the government itself. As Governor Palin said, "we need answers". Don't be afraid to ask questions.
