Over the last week or so, a new controversy has emerged about breast cancer screening. What has become the standard of screening over past years, has suddenly come in to question. Interestingly enough, this controversy demonstrates a perfect example of what life will be like under government health care.
For years, women have been told that they should do breast self-examinations and start their mammogram screening at age 40. On November 17, the U.S. Preventive Services Task Force, announced new guidelines that include the following:
-recommendation against women in their 40's receiving mammograms,
subject to individual patient needs and doctor input
-women in their 50's should receive biennial mammograms (every
other year)
-recommends against teaching women breast self-examination
Generally, I don't have a problem with these recommendations. However, I don't have a history of breast cancer in my family. On the other hand, we all know people who do and would not do well if these recommendations were adopted. We also know people with no family history who have developed breast cancer which was caught early either through self-examination or mammography.
Herein lies the problem. The USPSTF is an "independent government-appointed panel" (Washington Post, Rob Stein, 11/17/09). This is a highly influential panel made up of doctors and scientists. It's influence is felt as insurance companies and government agencies determine what care will be covered. Furthermore, "under health care reform legislation pending in Congress, the conclusions of the 16-member task force would set standards for what preventive health care services insurance plans would be required to cover at little or no cost". (Washington Post, Stein) If their recommendation becomes law, what will be the future results? Will women at high risk be able to get screening? If we are all forced on to the government plan (or should I say when?), will we be able to pay for services that are not covered? Where would that leave people that can't afford to pay full price for treatments that are not covered?
To the credit of the USPSTF, they did suggest that women make individual decisions in regards to their breast health. Unfortunately, that will neither be the result of their recommendations nor the pending legislation regarding health care. The American Cancer Society and the American College of Radiology have both strongly condemned the recommendation. It is also enlightening to know that the USPSTF panel includes neither an oncologist (cancer doc) or radiologist. By contrast, another recommendation was made in regards to women's health a couple of days later. The American College of Obstetricians and Gynecologists "has released new guidelines for when and how often women should have Pap smears. They include: Routine Paps starting at 21 and women waiting three years between Paps if they're over 30 and have had three consecutive clear tests." (L.A. Times, Shari Roan) This recommendation carries far more weight with me than that of the USPSTF, for several reasons. The ACOG is not a government entity, it includes doctors that specialize in women's health issues and I believe their sole motivation is to address the best way to treat their patients and efficiently utilize their resources.
Ultimately though, the main issue is obscured by all of these corollary discussions. These recommendations are all useful on a certain level. But in the end, each one of us should be having a conversation with our doctor about our medical needs. Treating an individual should never be reduced to tables, statistics and number crunching. I have neither a family history of breast cancer nor have I participated in the behaviors that will put me at risk for cervical cancer. I have also never had an abnormal Pap. Why can't my doctor and I sit down and determine what kind of breast or cervical cancer screening is appropriate to me? In the end, it would save the system money to treat ME and not the statistics. On the flip side, some of my friends should start having mammograms annually at age 30 based on their family history. Will that be paid for? (It is my understanding that in Canada, you cannot pay out-of-pocket for anything not covered under the government plan.) My fear is that, in the future, those decisions will be made for us by policy wonks and government panels; breast health will only be the beginning. The only realistic solution to our health care problems is to wrest control from the government and insurance companies and return it to the rightful owners: me and my doctor.
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