Lawmakers argue whether mammogram guidelines show what’s wrong with health care overhaul

By Philip Elliott, AP
Sunday, November 22, 2009

Mammogram guidelines spark debate over health bill

WASHINGTON — Lawmakers broke along party lines on a new aspect of the health care debate Sunday as a former National Institutes of Health chief urged women to ignore guidelines that delay the start of breast cancer screenings.

Republicans pointed to the guidelines as evidence the Democrats’ proposals for a health care overhaul would yield limits on mammograms and a rationing of care. Democrats dismissed those worries and said Republicans were stoking fears without facts.

Under the Democratic plan, a new independent institute would advise the health secretary. However, the health secretary would not be required to deny or extend coverage in a government-backed health plan based on recommendations from the institute.

A government-appointed panel said last week that women generally should begin routine mammograms in their 50s, rather than their 40s — sparking cries of outrage and claims a taxpayer-funded health care option wouldn’t pay for the screenings.

“I’m saying very powerfully ignore them, because unequivocally … this will increase the number of women dying of breast cancer,” said Dr. Bernadine Healy, a director of the National Institutes of Health under Republican President George H.W. Bush. “Women in their 40s have a very aggressive kind of breast cancer. They tend to progress fast. And to not screen women in that age group is astounding to me, and it goes against the bulk of individuals who are actually caring for patients.

A brain cancer patient who ran for the Senate as a Republican, Healy added: “You may save some money … but you’re not going to save lives.”

Sen. Kay Bailey Hutchison, a Texas Republican who is seeking her state’s governor’s office, said the new scientific data is “the beginning of rationing.” She said it will provide the government with an excuse not to provide payments for more frequent screenings and that insurance companies would then follow suit.

Rep. Marsha Blackburn, R-Tenn., said the recommendations will force Health and Human Services Secretary Kathleen Sebelius to exclude the preventive measures from any plan that receives government funds.

“They become the law, the mandate,” she said.

Safeguards against the dire situation Republican predict already exist. All states except Utah make insurers cover mammograms, and 20 states require coverage that starts at age 40, according to 2007 data compiled by the Washington-based National Women’s Law Center.

The U.S. Preventive Services Task Force issued its recommendations on Nov. 16, saying getting screened for breast cancer so early and so often leads to too many false alarms and unneeded biopsies without substantially improving women’s odds of survival.

“As a breast cancer survivor, I came out against these recommendations,” Rep. Debbie Wasserman Schultz, a Florida Democrat, said Sunday. “Every major cancer organization has come out against these recommendations. The task force language in that bill actually makes sure that … preventive services like mammograms and colonoscopies and other cancer screenings would be free.”

GOP lawmakers said the Democratic health care plan, which the Senate allowed to inch forward Saturday night and remains President Barack Obama’s top domestic priority, would set the nation toward massive government control.

“Do these recommendations make sense from a cost standpoint? Absolutely, from a cost standpoint, they’re right,” said Rep. Tom Coburn, an Oklahoma Republican who is a medical doctor. “From a patient standpoint, they’re atrocious. And that’s the problem with a bureaucracy stepping between a physician and their patient.”

Healy appeared on “Fox News Sunday” while Hutchison appeared on NBC’s “Meet the Press.” Blackburn, Wasserman Shultz and Coburn appeared on ABC’s “This Week.”


November 22, 2009: 5:47 pm

US women should realize that your doctor’s requirements are excessive in the first place and more likely to hurt you, than help you.
Other countries recommend mammograms from age 50 and 2-3 yearly for a reason. I have concerns about mammograms at any age, but at 40, the risks of testing are even higher…with very little benefit.
I’d recommend any woman thinking of having mammograms should look at the paper released by the Nordic Cochrane Institute - it is one of the only publications that gives women an honest assessment of the benefits AND risks of testing. It’s available on-line.
The call for fewer pap smears is well overdue - over-screening leads straight to over-treatment for false positives. The country with the lowest rates of cervical cancer tests women a total of 5-7 times in their lifetimes and sends far fewer women for biopsies and “treatment”.
American women should look at other countries - your system is excessive and harmful.
You don’t need this level of medical intervention and regulation in your lives.
Question the need for routine gyn exams as well - they are not recommended in most other countries - in asymtpomatic women they are of low clinical value and are more likely to harm you…as they often lead to further unnecessary and possibly, harmful testing. Routine breast exams and self-examination are not recommended in many countries as well - there is no evidence they reduce the death rate, but there is evidence they lead to unnecessary biopsies for false positives.
I think the US system is in desperate need of a shake-up - I’m not sure whether women’s health is shaped by defensive medicine or whether it’s money-making from healthy women - well, healthy at the start anyway…

will not be displayed