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Published: Monday, 11/30/2009

Mixed signals on health

AT A TIME when the economics of health care is being hotly debated, two advisory panels stirred a new hornet's nest with cancer-screening recommendations that gave an opening to opponents to unfairly claim that reform will lead to rationing of care.

While the intent of the U.S. Preventive Services Task Force's independent medical experts was ostensibly the welfare of women, their rejection of long-standing guidelines for early detection of breast cancer through mammograms was a serious blow to prevention.

The task force issued a stunning reversal of previous positions, saying women in their 40s don't need mammograms and women over 50 need them only every other year instead of annually. Interestingly, only one study examining the value of mammograms came out between the panel's last screening guidelines in 2002 and the current ones. That study, according to Dr. Gary Lyman, a breast cancer oncologist at Duke University who researches comparative effectiveness, did nothing to change what doctors know about mammograms.

Four days after the task force issued its report, the American College of Obstetricians and Gynecologists' recommended that women ages 21 and older have Pap smears less often and women under 21 forgo the test altogether.

That announcement, however, created much less furor because many professional groups, based on better knowledge of cervical cancer, already believe annual Pap smears, credited with reducing deaths from cervical cancer by more than 70 percent since the 1940s, are excessive.

Not surprisingly, the new recommendations against mammograms for some and delayed screenings for others have been met with widespread anger from doctors, medical centers, former and current cancer patients. Groups such as the American Cancer Society, the American College of Radiology, and the Society of Breast Imaging immediately denounced the guidelines as potentially very harmful to women.

The two announcements could not have come at a worse time in the health-care debate. Taken together, they provided political ammunition to those happy to prey on fear, who were quick to claim that cost drove the task force's recommendations and label them the first step on the path to rationed health care.

Kathleen Sebelius, secretary of health and human services, quickly responded that there won't be any rationing of mammograms on her watch. The task force, she pointed out, does "not set federal policy and they don't determine what services are covered by the federal government."

Setting aside the callous political use to which these reports have been put, the advisory to forgo mammograms and self-exams could be the excuse some women need to decline screenings, which can be uncomfortable. Others who heed the panel's recommendations may miss detecting the disease at its most treatable stage.

It may be true that few lives will be saved by beginning mammograms at 40 and regular self-exams at every age. But since when is even one life saved not enough?



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