Home › Blogs › mgoozner's blog

Mammography Under 50

by GoozNews ~ 17 Nov 2009 09:20am

The U.S. Preventive Services Task Force did the right thing yesterday, as regular readers of Health Tech Review knew after reading this Oct. 4, 2009 story, "The DCIS Dilemma: Time to Change the Name?" So when a story is everywhere, perhaps the only new value I can add is to highlight one issue mentioned in all the stories but left unquanitified: costs.

Here's the data presented in the New York Times story: "One cancer death is prevented for every 1,904 women age 40 to 49 who are screened for 10 years, compared with one death for every 1,339 women age 50 to 74, and one death for every 377 women age 60 to 69."

And here's a quote from a Harvard radiologist, offered up by the Washington Post: "Tens of thousands of lives are being saved by mammography screening, and these idiots want to do away with it," said Daniel B. Kopans, a radiology professor at Harvard Medical School. "It's crazy -- unethical, really."

Now let's do the math. To save Dr. Kopans' 10,000 lives by screening women under 50, it would require screening 19 million women for ten years or 190 million mammograms. At a conservative $200 per mammogram (all costs: the x-ray, the doctor's visit, the ancillary costs), that comes to $38 billion. That $3.8 million per saved life. Of course, this doesn't include the costs of treating all the false positives and non-invasive ductal carcinoma in situ growths (about 20 percent of all positive findings using mammography).

Now let's look for another potential use for that 10-year, $38 billion health care program. You could spend $200 a year over those ten years on smoking cessation counseling for 19 million smokers. Don't you think that more targeted program at people at risk would have a greater impact on lowering cancer incidence and save more lives -- including women's lives? Heck, given that smoking is a major risk factor for breast cancer, it could even lower the breast cancer rate and reduce breast cancer deaths.

Which use of the $38 billion would eliminate the greatest number of breast cancer deaths requires more statistical data than I can command at 8 a.m. on a Tuesday morning. But I'd bet the value of all the tobacco grown in Kentucky on which one would save the most lives overall. My bet wouldn't be on mammography.

 

Comments

Okay, using your logic, if we

Tue, 11/17/2009 - 13:27 — mendskyz

Okay, using your logic, if we are looking stictly at dollars and cents, it would be better to concentrate all of the money spent on gun control and redirect that money to cancer since for every 100,000 people, only about 10 die each year from guns while about 53 die from breast cancer between the ages of 40 - 49.


http://www.gun-control-network.org/GF01.htm


Are you ignorant or just stupid.  If it were your spouse that died in her 40's because she took this advice and was waiting until she was 50 to be screened for breast cancer I am sure you wouldn't say, "Oh well, at least we saved $38 Billion.  Your figures also don't take into consideration the damage the death of this 1 in 1904 women does to their families, especially the children


I also suggest that your stupidity is outweighed by your obvious leanings toward government controlled health care since this is an obvious first move on the part of the government to ration health care.

»

From the report, "mammography

Tue, 11/17/2009 - 23:25 — gpawelski

From the report, "mammography screening at any age is a tradeoff of a continuum of benefits and harms. The ages at which this tradeoff becomes acceptable to individuals and society are not clearly resolved by the available evidence.” 

»

Before blatantly criticizing

Wed, 11/18/2009 - 11:11 — gpawelski

Before blatantly criticizing someone as being ignorant or just stupid, and then giving an auspicious example if it were your spouse that died in her 40's routine, what if it were your spouse that was diagnosed with ductal carcinoma in situ, a dormant cancer which does not spread and may never have caused problems, and doctors advised her to have a mastectomy in case it might spread? The reality had been two wide excisions, one partial mutilation, one reconstruction, five weeks' radiotherapy, chronic infection, four bouts of cellulitis, several general anaesthetics and more than a year off work. All because of an earlier-than-advisable screening process?

And as far as referring to the independent panels' recommendation as a sign of what's to come with Obamacare, the US Preventive Services Task Force is not the US government or a panel of government officials. The task force is made up of independent primary care doctors and others whose stated interests include decision modeling and evaluation, effectiveness in clinical preventive medicine, clinical epidemiology, and the prevention of high-risk behaviors.

Research by the Nordic Cochrane Centre in Denmark raised questions about the effectiveness of mammography. In a study of 2000 women, they found that one woman would have her life prolonged but 10 would undergo unnecessary treatment and 200 women would experience unnecessary anxiety because of false positive results. According to the authors of the study, it is "not clear whether screening does more good than harm."

We would like to believe that medical advice we get is based solely on good medical practice and evidence-based medicine. It is also important to note that companies like General Electric and DuPont, both which manufacture mammography equipment, are large donors to organizations such as the American Cancer Society.

»

My point is if the private

Wed, 11/18/2009 - 13:19 — mendskyz

My point is if the private sector is allowed to work and government got out of the way then there would be plenty money for the care that is needed.  The government is the cause of the current supposed Health Care crisis and more involvement by the government will only make the problem worse.


What makes any two types of care mutually exclusive?  Why can't we have both.  The answer is that they aren't and we can.  It wasn't until the Government got into the mix that Health Care costs started sky rocketing. and let's not forget tort reform which isn't even in the supposed Health Care Reform (ha!) bill.

»

A significant number of

Wed, 11/18/2009 - 14:27 — gpawelski



A significant number of Americans believe that the answer to our health care problems is to rely on the free market. Health care can’t be marketed like bread or TVs.

There are two strongly distinctive aspects of health care. One is that you don’t know when or whether you’ll need care, but if you do, the care can be extremely expensive.

It must be largely paid for by some kind of insurance. And this in turn means that someone other than the patient ends up making decisions about what to buy.

Consumer choice is nonsense when it comes to health care. And you can’t just trust insurance companies either, they’re not in business for their health, or yours.

The problem is made worse by the fact that actually paying for your health care is a loss from an insurers’ point of view, they actually refer to it as “medical costs.” This means both that insurers try to deny as many claims as possible, and that they try to avoid covering people who are actually likely to need care.

Both of these strategies use a lot of resources, which is why private insurance has much higher administrative costs than single-payer systems.

The second thing about health care is that it’s complicated, and you can’t rely on experience or comparison shopping. That’s why doctors are supposed to follow an ethical code, why we expect more from them than from bakers or grocery store owners.

You could rely on a health maintenance organization to make the hard choices and do the cost management, and to some extent we do. But HMOs have been highly limited in their ability to achieve cost-effectiveness because people don’t trust them, they’re profit-making institutions, and your treatment is their cost.

Between those two factors, health care just doesn’t work as a standard market story.

There is not one function that private insurance corporations perform more effectively or efficiently than Medicare insurance in age matched controls. There’s not one medical, surgical or preventative outcome that’s improved by private insurance corporations when compared to medicare in age and sex matched controls.

We have to ask ourselves as a nation and as human beings, why we continue to divert $750 billion per year from patients, doctors, hospitals, therapists and pharmaceuticals into the pockets of insurance company bureaucrats, executives and shareholders?

We must streamline the administrative process so doctors, hospitals and patients are free to practice and receive health care respectively without the deleterious and financially damaging consequences forced on all parties by the health insurance pharmaceutical industrial complex. It’s the worst kind of fraud diverting funds from patient care.

And why tort reform will not work is that the DOCTORS ARE THE INSURANCE COMPANIES. According to the Physician Insurers Association of America, a trade group of about 50 doctor-owned malpractice insurers, they cover about 60% of U.S. doctors in private practice and hospitals.

Why is it the profits of these doctor-owned insurance companies that doctors want to protect?

Limits on the rights of people hurt by medical malpractice will victimize them and their families further while helping neither patients nor doctors. The real beneficiaries will be insurance companies, including the doctor-owned malpractice insurers.

The real malpractice crisis is the fraction of doctors who commit most of the negligence and medical errors. Just 5.3% of doctors are responsible for 56% of medical malpractice payouts nationally, according to the NPDB. Doctors who get sued this often are bad doctors. Of those bad doctors, only 7.6% have ever been disciplined by state medical boards.

The only people who benefit by medical malpractice reform are the doctors and hospitals who commit the malpractice in the first place. Why should innocent victim's rights to seek compensation be limited? That just rewards the wrongdoers. To help eliminate medical malpractice, state Medical boards have to do a better job of weeding out the bad doctors who cause most of the harm.

Tort reform isn't about fixing a "broken" justice system; it's about protecting the public image and bottom lines of the biggest and most powerful companies in the world. Tort reform isn't about protecting doctors from high insurance rates; it's about protecting their insurers from having to pay large judgments. Tort reform isn't about keeping "greedy lawyers" from filing frivolous lawsuits; it's about keeping those who are severely injured out of the court system and away from the public eye.

»

You're a mindless liberal

Fri, 11/20/2009 - 14:51 — mendskyz

You're a mindless liberal robot. 


IT IS ALL ABOUT PERSONAL RESPONSIBILITY!!!!!!!


This country is full of lazy, give me a handout type people who are looking to sit on their duffs collecting free money, and waiting on the government to tell them where to go, what to do, and how to speak.


There was a time in the country when everybody didn't sue everybody and things were just great.  People should be responsible for themselves and stop relying on the get rich quick through law suits and take ownership for their own well being.  I came from a relatively poor family, went to one of the poorest schools in the country and didn't get a college education.  I now make an average of $200K year and I did it through hard work and dilligence.  If I can do then anybody can.  Government should be there for the handicap and the mentally ill.  Everyone else should be responsible for themselves.  Bottom line, if you don't work then you don't eat and you don't get paid. Tough shit, you're born, you live and you die, some sooner than others.  If we purge the gene pool of all the lazy, hand out mentality people then eventually we will have a stronger free nation.


I don't want to see my hard earned dollars go to the sorry a$$ people who refuse to work and sit around and wait for the government to fullfill all their needs while they drive around in cars with expensive stereo equipment, $5000 worth of rims and tires, talking on their $400 cell phones that cost $125/month for service while they are constantly whining about not being able to afford their health care.  Of the so called 46M people without health care, about 1/2 have chosen to not carry it because they are young.  Another several million are illegal aliens that should NOT be entitled to ANY government services.  They should go back to their country and come here legally.  The rest have to deal with reality.  I shouldn't have to pay for their mistakes or their illnesses.  You think all the tribes in Africa have health care?  Hell they don't even have a warm place to sleep yet they survive, they enjoy life, and they don't wait around for the government to give them handouts.


Your mentality about EVIL corporations taking advantage of the poor man is such a cliché.  If corporations are the problem then regulate them, don't force me to pay for every lazy A$$ that doesn't want to take responsibility for themselves


I want what the constitution says I have a right to, and nothing more.  Life, LIBERTY, and the pursuit of Happiness.


The constitution doesn't say anything about guaranteed housing, health care, meals, or education.


You tell me why MY HARD WORK, AND HARD EARNED MONEY should be forcefully taken away from me to pay for the lazy and the sorry.


I am trying to be responsible for myself, save money, and prepare myself for a self sufficient retirement but with the government taking more and more of my money away from me that is becoming increasingly impossible.


I can't believe you would put your faith in ANY governmental body, especially one that has raped and pillaged the social security fund, proven time and time again that it can't provide cost effective health care, and has demonstrated nothing but their desire to get more and more control of your money.   I would bet my life ANY DAY on the so called EVIL corporations before I would put one ounce of trust in my federal government in its current state.

»

LOL! We changed

Fri, 11/20/2009 - 16:20 — gpawelski

LOL! We changed Administrations this year. The last one is over and done with. New Sheriff in town.

»