Mammogram panels?

The timing couldn’t possibly have been worse for the government to release new guidelines on when women should have mammograms to detect breast cancer early enough to save their lives — right in the middle of the nation’s health care debate over the role of government in health care decisions.

The guidelines, if you haven’t heard, recommend women not have mammograms until age 50, instead of age 40, as most groups who research the issue suggest.

“There is no doubt that mammography screening in women in their 40s saves lives. To recommend that women abandon that is absolutely horrifying to me,” Dr. David Dershaw, director of breast imaging at Memorial Sloan-Kettering Cancer Center said.

So why did they? Dr. Otis Brawley of the American Cancer Society suggests cost is behind this:


The USPSTF says that screening 1,339 women in their 50s to save one life makes screening worthwhile in that age group. Yet USPSTF also says screening 1,904 women ages 40 to 49 in order to save one life is not worthwhile. The American Cancer Society feels that in both cases, the lifesaving benefits of screening outweigh any potential harms. Surveys of women show that they are aware of these limitations, and also place high value on detecting breast cancer early.

“With its new recommendations, the USPSTF is essentially telling women that mammography at age 40 to 49 saves lives; just not enough of them.

And what Brawley didn’t say, Dr. Sanjay Gupta did. Gupta, who was Barack Obama’s initial choice for surgeon general before he decided to stay at CNN, speculated today that once the government recommends guidelines for medical care, private insurance companies will be quick to stop covering anything else.

Not death panels, mamography panels. It’s worth pointing out, perhaps, that the government’s guidelines now match Canada.

But Susan Pisano, spokeswoman for American Health Insurance Plans, appears to dismiss the concerns:


“Most of our member companies look at [the task force's guidelines] as the standard. But if you are in your 40s and have a discussion about risk and benefits and your doctor gives you a referral slip, then that generally is going to be covered.”

Still, the story does highlight the extent to which cost factors into health care decisions, even after the possibility a life being saved is recognized.