New Women’s Health Guidelines Put Money Over Health Care
Last week a federal panel released new health care guidelines for women. According to the panel, annual mammograms are not recommended for women under the age of 50, and pap smears only need to be given every three years for sexually active women. When I heard the news on NPR, I was pretty disgusted by the whole tenor of the conversation. Basically, the decision to tell women under 50 that they don’t need to get a mammogram every year was based on money. The doctors that NPR interviewed said that 1900 women would have to be screened to save 1 life, and that it wasn’t worth the cost. I’m all for bringing down health care costs and trying to avoid unnecessary medical procedures. But if a government panel had given a similar recommendation to men saying that they didn’t need to get their balls checked out for prostate cancer because it wasn’t worth the cost, please believe that there would be outrage in the streets.
NPR’s discussion about pap smears was totally patronizing. The male doctors that they interviewed talked about invasive procedures giving women emotional trauma. As if women are too emotionally unstable to deal with a pap smear. Sure, I’ve got lots of things that I’d rather do with my time than get a speculum shoved up my coochie. But regular cancer screenings seem like a good idea to me. Then again, I don’t have a medical degree.
A very close friend of mine is a breast cancer survivor. She was really lucky – she had gone in for her annual exam and the doctor noticed a discolored mole. She was able to get a mammogram and a biopsy within days, and they started treating her for breast cancer. The type of cancer she had was particularly virulent, and she is very lucky that they caught it so early. She was under 40. Under the new federal guidelines, her cancer probably wouldn’t have been caught in time. I’ve had a doctor order a mammogram for me and the insurance company refused to pay for it because I was too young. Under the new guidelines, I think this is going to be the mantra that most women hear. It’s all well and good to say that health care decisions should be made between a woman and her doctor, but at the end of the day it’s going to be the insurance companies calling the shots.
Where is the reciprocal recommendations for men’s health care? Why are women bearing the burden of reducing American’s health care costs? It’s time to stop putting profits over health care. Period.
1Sharon
wrote on 28 November 2009 at 12:49
I’m a (female) physician specializing in women’s health, and I love your blog and your writing. I think that the coverage of the new screening guidelines has been quite flawed, and you are picking up on that. But that doesn’t mean that we need to throw the guidelines out.
Starting with the mammogram issue: The USPSTF does not base its decisions on monetary costs. It does look at the costs to women of unnecessary biopsies, treatment, and even the chemo and surgery some women undergo unnecessarily. Upon reviewing the evidence, the panel concluded that the evidence screening women under age 50 is far from persuasive, and recommends that decision be kept between a woman and her doctor based on her personal history and values. They also concluded that we can safely screen every 2 years rather than every year. This is not as radical a shift as some are claiming. The evidence has been iffy for years, the move to recommend screening for women under 50 was political rather than scientific, and in other countries such as Canada and UK they start screening at 50. I know that we’ve been taught for years that early detection = early cure. It seems to make sense. Unfortunately, it’s just not generally true. Rather than try to make the science something that it’s not, let’s focus on advocating for finding ways that we truly can pick up cancer at an early enough stage that we can make a real difference in treating it. Mammograms have been oversold, and as a result women have missed out on the opportunity to advocate for the development of better technologies.
In terms of cervical cancer screening, the new recommendations are not to start until age 21 (which is great because it’s one less barrier for young women to get the contraception they need!) and to space out screening to every 2 years in women . The reason this is fine is that the vast majority of pre-cancerous lesions resolve on their own. Even those that don’t resolve grow extremely slowly, leaving plenty of time to treat them. By decreasing the number of screenings we’re decreasing the number of biopsies, and therefore decreasing the number of more extensive procedures done. This is good because some of the surgeries to remove the abnormal cells can put a woman at risk of pre-term labor in the future.
And believe it or not, the USPSTF has also recommended against the routine screening we had been doing for prostate cancer, so we can’t blame this entirely on sexism!
I agree that we do hear about the “anxiety” factor of these tests a whole lot more when they’re for women’s health issues than men’s health issues, and that’s clearly a product of our societal norms. And I totally understand that hearing a man saying that the anxiety is the biggest problem is demeaning. But the bottom line is that these new recommendations are made with the best interests of women in mind. What we need to do is ensure that the decision to screen or not to screen remains between a woman and her doctor, and that further future efforts be made to give us access to better screening methods for breast cancer. (The screening for cervical cancer is actually a very good test; the mammogram is not so great).
As to the case you cite above, your friend, these recommendations would have had no effect on her whatsoever. Remember that they apply to *screening* tests, which look for something that hasn’t made itself apparent. Your friend had an abnormality that her doctor noticed, and her doctor did a *diagnostic* mammogram. All bets are off if there are symptoms or other concerning findings, a very strong family history (in terms of breast cancer, a mother or a sister), or other individual reasons.
Let’s try to look at these guidelines as a step forward. It charts a clear course for our advocacy for the future: better treatments for breast cancer and better screening tests.
2freewomyn
wrote on 1 December 2009 at 22:49
Thanks for the clarification – that was definitely not included in the NPR story.
3Eliz 52
wrote on 5 August 2010 at 6:24
I totally disagree that the pap smear is a good screening test.
That is the propaganda that has been fed to women for decades while doctors desperately fudge figures to show how effective the program has been and attempt to hide the vast amount of damage.
Cervical cancer is uncommon, some would say rare.
Screening tests can only be offered with complete information, as we’ve seen with prostate screening – informed consent is a legal requirement because you’re offering a healthy person something that has risks and benefits.
That has never been respected in women’s healthcare, we get half the story, skewed statistics, extreme pressure to screen & coercion is frequently used with doctors refusing women the Pill UNTIL they screen (the Pill has nothing to do with screening)…
I don’t believe cervical screening would be permitted today, a test that causes vast over-detection and harmful over-treatment of healthy women to help so few would be considered inappropriate and unethical.
Not telling women the truth does not make it better.
Richard DeMay, the American pathologist, tells us that 0.65% of women benefit from smears, that means 99.35% derive no benefit at all (incl the 0.35% who get false negatives)…but reckless and over-screening that occurs in the States means 95% of women will be referred for a colposcopy and usually some form of biopsy in her lifetime. Some of these women are left with damage after unnecessary treatment…around 95% of all referrals are unnecessary and for false positives. Infertility, miscarriages, problems during pregnancy, premature babies, more c-sections and psych problems.
All for 0.65% of women and with no informed consent.
Yet doctors hail this test as a huge success..I guess the cervix is not a valued piece of womanhood.
The excess in the States is horrifying…testing virgins, women in lifetime monogamous relationships, women who’ve had complete hysterectomies for non-cancerous conditions, screening women under 25 and elderly women & over-screening…inappropriate screening causes huge harm for zero benefit. It does make lots of money for doctors and day procedure centres though…
It has been shown that screening does not change the tiny death rate in women under 25 (some would say 30)…it is unsafe, unreliable and completely useless in young women and doctors have known that for many years. Screening young women produces VERY high numbers of false positives and causes serious over-treatment.
Dr Raffle, UK cervical screening expert, told us in 2003 (in the BMJ) that 1000 women need regular smears for 35 years to save ONE woman from cc…now factor in the damage done to healthy women over those years.
It’s time to do our own reading and protect our healthy bodies – cancer is a much smaller threat than doctors and their “good” screening programs.
Anyone after the truth, go to Dr Joel Sherman’s medical privacy blog under women’s privacy issues. (all of my statistics appear there)
There are problems/risks with mammograms as well – read the article, “The risks and benefits of mammograms” at the Nordic Cochrane Institute website, an unbiased summary of the facts.
Also, the annual gyn exam pushed at American women are completely unnecessary and risk your health. They are not evidence based, the routine pelvic is of low to poor clinical value and carries risk. (further unnecessary investigations and even surgery)
Routine breast exams do not affect the death rate, but cause biopsies which some believe are a risk factor for cancer.
Time to get informed…whether you screen or not, make it YOUR informed decision.