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.