The recent uproar over new mammogram guidelines is as ironic as it is misguided. The fact that the US Preventive Services Taskforce voted on the updated recommendations in June 2008, before Obama ever took office, is apparently irrelevant to all the fear-mongering blowhards out there. So is the fact that mammograms rarely catch tumors for women in their 40s, due to breast density causing false positives. Government healthcare rationing, no – the task force didn’t even include costs in its analysis. Updated clinical guideline based on plenty of evidence, yes. The American College of Preventive Medicine lauded the task force’s methods as exactly the kind of analysis we should be doing. But that won’t bother anyone.

The taskforce recommendation (just like the one in 1997 that Congress overruled) is to delay the start of routine mammograms until a woman reaches the age of 50, and then begin screenings every two years. Diana Petitti, MD, MPH, Task Force Vice Chair, summed it up nicely: "So, what does this mean if you are a woman in your 40s? You should talk to your doctor and make an informed decision about whether a mammography is right for you based on your family history, general health, and personal values." In other words, Dr. Petitti is not saying women shouldn’t be screened under any circumstances, she’s saying doctors and their patients should put more thought into whether it will be of benefit.

That’s excellent advice, but one which neither Congress nor most physicians are heeding. Many physicians interviewed by the New York Times said they weren’t ready for such a “drastic change”.  There seem to be a lot of these drastic proposed healthcare changes that have been around for decades, don’t there? Hopefully physicians’ resistance is not because they’re listening to the hundreds of ignorant Joe the Plumbers we have running around Congress. Because if they are, women are once again getting the short end of the stick in recent healthcare politics.

Part of the apparent conflict here is the imminent vote on the EARLY (Education and Awareness Requires Learning Young) Act. The Act, which has over 360 co-sponsors in the House and 35 in the Senate, will help younger adult women know their breast cancer risk and take appropriate steps to optimize their health. Again, mammograms are not very helpful in younger women. But there is also HALO, a minimally invasive, 5-minute test based on nipple aspiration fluid (NAF), available, and even genetic profiling in more extreme cases. HALO can detect the presence of abnormal cells – which increases the risk of developing breast cancer by 4-5 times – in NAF. That’s important, as 70% of women diagnosed with breast cancer have no typical family or personal risk factors.

Let’s talk about evidence-based medicine for a minute. Remember, the idea is to recommend treatments that, based on clinical evidence, are effective. Comparative effectiveness research then compares treatments to determine which ones are most effective. Critics say this whole preferential treatment business encourages the profit motive, apparently forgetting history. Before the FDA there were miracle potions and elixirs by the hundreds, none of which worked but all of which made nice profits. Plus, leaving the decision whether to do a procedure up to a profit-driven marketplace, one that is paid more for doing more procedures, leads to an obvious over-treatment outcome.

Wouldn’t you rather be paying for something that actually worked with your hard-earned healthcare dollars? By the time a mammogram picks up a tumor, it has typically been growing for 8 years. But breast cancer survival is directly linked to early diagnosis. Insurers still don’t cover HALO (about $100), but they do cover mammograms (about $125.) Typically we consider paying less for more – more accuracy, more time-sensitivity, more effectiveness – a good thing. So instead of jumping on the US Prevention Task Force witch hunt bandwagon, please pass this message on to the women in your life: earlier IS better, the EARLY Act is a winner, and mammograms are not the early prescription.

Bonus video exposing just who the bureaucrats are in the mammogram debate:

Photo LovinArizona // CC BY 2.0

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