The recent brouhaha created by the ill timed, ill worded, ill phrased (or is it just ill) report from the USPSTF (US Preventative Services Task Force) has stirred the pot to be sure.  We support individualized treatment of patients.  We applaud the tailoring of medical testing and procedures to individual needs and circumstances based on dialogue between patient and physician.  The problem with these “task forces” and their pronouncements is that they color the insurance market and reimbursement policy.  The rapidity with which Secretary Sebelius distanced herself, her department and the administration from these recommendations speaks volumes. This report is the proverbial hot potato and nobody in politically correct Washington DC wants to touch it.  The sad part is that we know that early detection saves lives.  The task forces concern for the ‘anxiety’ caused to women, was from our perspective, frankly, condescending, implying that women (females) may be too fraught with anxiety to deal with uncertainties regarding medical tests and their outcomes.  This perspective, whether intentional or not, is balderdash (Colonel Potter’s favorite expletive on MASH).  Arguments about mammography and its proper role are not new.  We site several comments from various sources below on this vary issue.  However, we continue to find any recommendation that suggests that physicians should limit physical examinations as an anathema. Also, suggesting that women, or patients in general, not be familiar with their own bodies is, in our belief, outside the mainstream of modern health thinking.  Self examination is proper, useful and helpful to early detection.  Proper physical examination by a physician or trained health professional is always appropriate. It would a shame to forgo the most respected and time tested traditions of medicine in a move to limit “anxiety” among patients.  Anxiety is relieved by information.  Making a diagnosis is never wrong.  Patients can be counseled on options of treatment if and when a diagnosis is made.  They can also be counseled on the options regarding diagnostic procedures.  We believe, that in the end, doctors and their patients, together make the best decisions . . . obi jo and jomaxx

Between 1950 and the late 1980s, overall death rates from breast cancer were relatively stable, according to the ACS publication, Breast Cancer Facts & Figures 2001-2002. The death rates for breast cancer then began to fall, dropping by about 1.6% each year between 1989 and 1995. Between 1995 and 1998, the drop in the rates picked up speed, declining about 3.4% each year.  Among the women screened with mammography during that time, deaths from breast cancer dropped by 63% compared to the 10 years before that when widespread mammography wasn’t available. Mammography makes such a large difference, notes Smith, because it can find tumors early when they are still small and more likely to be treated successfully.  Smith says the present decline in breast cancer death rates can be expected to continue to accelerate, but only if mammography — and access to it — continue to improve. “There really is an enormous advantage to treating a tumor when it’s smaller,” notes Smith. “That’s really the bottom line.” …..

Breast Cancer Death Rates Continue to Decline: Mammography Is Key; Treatments and Awareness Credited, Too – http://www.cancer.org/docroot/NWS/content/NWS_1_1x_Breast_Cancer_Death_Rates_Continue_to_Decline.asp

American Cancer Society recommendations for early breast cancer detection
– Women age 40 and older should have a screening mammogram every year and should continue to do so for as long as they are in good health.

– Women in their 20s and 30s should have a clinical breast exam (CBE) as part of a periodic (regular) health exam by a health professional, at least every 3 years. After age 40, women should have a breast exam by a health professional every year.

– Breast self exam (BSE) is an option for women starting in their 20s. Women should be told about the benefits and limitations of BSE. Women should report any breast changes to their health professional right away.

– Women at high risk (greater than 20% lifetime risk) should get an MRI and a mammogram every year. Women at moderately increased risk (15% to 20% lifetime risk) should talk with their doctors about the benefits and limitations of adding MRI screening to their yearly mammogram. Yearly MRI screening is not recommended for women whose lifetime risk of breast cancer is less than 15%……

Can Breast Cancer Be Found Early? – http://www.cancer.org/docroot/CRI/content/CRI_2_4_3X_Can_breast_cancer_be_found_early_5.asp?rnav=cri

Bernadine Healy, first woman to head the agency, said lives could be at risk. The fallout from last week’s controversial recommendation that women delay the start of routine mammogram testing for breast cancer continues, with a former head of the U.S. National Institutes of Health advising women to ignore the guidelines. “I’m saying very powerfully ignore them, because unequivocally this will increase the number of women dying of breast cancer,” said Dr. Bernadine Healy, who was nominated to head the federal agency in 1991 by then-President George H.W. Bush. “Women in their 40s have a very aggressive kind of breast cancer. They tend to progress fast. And to not screen women in that age group is astounding to me, and it goes against the bulk of individuals who are actually caring for patients,” said Healy, the first woman to lead the National Institutes of Health and currently the health editor at U.S. News & World Report. She made her comments Sunday during an appearance on the TV news program Fox News Sunday. The controversial recommendation, released by an independent panel, said that women don’t need to start undergoing mammograms until age 50, and then only need one every other year. Long-standing guidelines have said women should have annual mammograms after age 40. The independent panel, the U.S. Preventive Services Task Force, said its recommendation was based on the latest and most accurate studies. Many women immediately wondered if the guidelines would affect their insurance coverage for the breast cancer tests…..

Women Should Ignore New Mammogram Guideline, Ex-NIH Chief Says – http://health.usnews.com/articles/health/healthday/2009/11/23/women-should-ignore-new-mammogram-guideline-ex.html

There has been a longstanding debate over the most appropriate age to begin mammography screening and the frequency of screening examinations. As with all screening tests, the decision to perform a mammogram must include an evaluation of the benefits and the risks of the screening tool, as well as a consideration of patient preference. The recent controversy about mammography should not suggest that there is debate about the most important issues. Most breast cancer experts agree far more than they disagree. For example, there is no debate that mammography reduces the risk of dying from breast cancer. As stated in the new USPSTF recommendations, extensive scientific evidence demonstrates that mammography reduces breast cancer mortality both among women aged 50 and older, as well as among women aged 40 to 49……

Susan G. Komen for the Cure® Scientific Advisory Board’s Perspective on the U.S. Preventive Services Task Force (USPSTF) Recommendations on Breast Screening – http://ww5.komen.org/ContentSimpleLeft.aspx?id=6442451488

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