Big Fat Story
Some women will suffer, but far more will benefit.
The anger spurred by the publication of new guidelines for cancer screenings isn’t about healthcare rationing or cutting costs, writes the New York Times: it’s about a different way of thinking about risk. When the Preventive Services Task Force recommended that women delay routine mammograms until age 50, they based their findings on a weighing of the risks of the screenings (“over-diagnosis, anxiety, false-positive test results and excess biopsies") against the benefits of the screenings ("one death prevented out of every 1,904 women—a number that drops precipitously as women grow older). Essentially, the task force is saying that, yes, the new guidelines may cause a small handful of additional deaths, but far more women will benefit in other ways. Many Americans, however, find it difficult to consider such a dispassionate cost-benefit analysis in their own health decisions. “People are being asked to think differently about risk,” says Sheila M. Rothman of Columbia University. “They don’t see it in a scientific perspective.”
"Screening has caused me considerable harm."
Though many are up in arms over new recommendations for less frequent cancer screening in women, some former patients wish they'd skipped the testing they got. One patient in the UK was advised to get a double mastectomy after being diagnosed with a mild form of cancer that may never have ended up spreading, and said that “screening has caused me considerable and lasting harm. It has certainly not saved or prolonged my life.” Though screening saves 1,400 lives each year in the UK, new research shows that if 2,000 women are tested over a decade-long period, 10 women will be given unnecessary treatment for every one woman who is saved. Gratuitous treatment can range from removal or partial removal of breasts, chemotherapy, and radiotherapy, and the UK government has had to rewrite its warnings about screening to include these risks. “It is infantilising women,” said the patient of the screening process. “It is patting them on the head and saying ‘There, there, it will be all right.’ It is entirely dishonest.”
Photo: Andreas Rentz / Getty Images
Says it's a sneak-peek at government-run health care.
Sensing blood in the water, Republicans leapt on the new mammogram and pap smear recommendations almost immediately, decrying the new guidelines as the first step toward the rationing of healthcare. “This is how rationing begins,” said Tennessee Senator Marsha Blackburn, while Alaska Senator Lisa Murkowski, hoping to scuttle the new White House-backed healthcare legislation, called the report “a peek under the curtain, if you will, of what we can expect with a government-run program.” Berkeley linguistics professor George Lakoff says the GOP’s ability to capitalize on the announcement is partly the Democrat’s fault: “They let the moral argument go and had it become an economic argument. As soon as it became a moral argument, they had to bring in cost-benefit analysis. As soon as it goes into cost-benefit analysis, the right wing can attack it as ‘death panels.’”
Photo: AP Photo
Breast Cancer's Death Panels?
New breast-cancer screening guidelines are being called smart science by researchers—and signs of health care "rationing" by others. The Daily Beast separates fact from fiction.
This debate isn't likely to settle anything.
As the debate rages over the new screening guidelines, the Washington Post points out that it’s not the first time politics and breast health have created controversy: a similar recommendation twelve years ago spurred controversy as well, eventually resulting in congressional hearings and a unanimous Senate rejection of the findings. A National Institutes of Health panel convened in 1997 and advised that routine screenings for women in their 40s may not be advisable given the risks; the Senate, after holding hearings, later voted 98-0 to recommend that the National Cancer Advisory Board endorse the opposite view. And in 2002, the same group that released this week’s recommendations—the Preventive Services Task Force—went the opposite way and advised screenings for the age group in question. The debate over early screenings is “decades-long,” says the Post, and this week’s storm of disagreement isn’t likely to settle anything.
Photo: Michael Dwyer / AP Photo
Some worry that backlash will be a setback to solid research.
As the American Cancer Society and Kathleen Sebelius come out against the new recommendations, some advocates of “comparative effectiveness” research—i.e., studying what treatments are most beneficial (and, incidentally, cost-effective)—worry that the reaction to the Preventive Services Task Force’s announcement will turn some against the movement to include more evidence in medical treatments. Health writer Merrill Goozner points out that stopping routine screenings for women in their forties could save as much as $2 billion, money that could be used to provide cancer prevention education and free screenings for women at high risk. Dr. Kevin Pho, a New Hampshire internist, sees the adverse reaction as damning: “If recommendations from an entity like the USPSTF—as non-partisan and robust as it gets—gets so much resistance from doctors, patients, and even the government itself, findings from a comparative effectiveness body stand absolutely no chance of changing medical practice.”
This debate isn't likely to settle anything.
As the debate rages over the new screening guidelines, the Washington Post points out that it’s not the first time politics and breast health have created controversy: a similar recommendation twelve years ago spurred controversy as well, eventually resulting in congressional hearings and a unanimous Senate rejection of the findings. A National Institutes of Health panel convened in 1997 and advised that routine screenings for women in their 40s may not be advisable given the risks; the Senate, after holding hearings, later voted 98-0 to recommend that the National Cancer Advisory Board endorse the opposite view. And in 2002, the same group that released this week’s recommendations—the Preventive Services Task Force—went the opposite way and advised screenings for the age group in question. The debate over early screenings is “decades-long,” says the Post, and this week’s storm of disagreement isn’t likely to settle anything.
Photo: Michael Dwyer / AP Photo
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