The Best Breast Cancer Screening

Physicians and patients alike are in a quandary as to which is the best screening modality for breast cancer.

The U.S. Preventive Services Task Force  set out to answer this question.

Analyzing  data for five different modalities, results  were evaluated.

The modalities compared were:

  • film mammography
  • digital mammography
  • magnetic resonance imaging
  • clinical brest examination
  • breast self-examination
After all the results were tabulated, they were deemed inconclusive.  However, they did feel that breast self-examination was not necessary.
It seems that if just one life is saved because self-examination is done and after finding a lump, seeks corrective treatment, then the process will have been well worth it.
Are we going to rate the importance of lives along with the return of investment now?

Don’t Ask,Don’t Tell…No Test, You’re Well

In the latest effort to keep healthcare costs down following on the heels of the mammography guidelines change, comes a revision on the need for annual pap smears.

The latest evidence-based recommendations  issed by ACOG (American College of Obstetricians and Gynecologists) were posted November 20, 2009.

Screening Rate Change

The initial cytology screen has been moved to 21 year old women as opposed to screening 3 years after first sexual intercourse or age 21 which was the former policy.  This is contrary to the need to perform the test when a person has been exposed to HPV (which in most cases would not be known without the test).

Sexually active women under 21 should be counselled and tested for sexually transmitted diseases as well as contraception and safe sexual practices.  A speculum examination need not be performed. 

ACOG now recommends that cervical screening be performed once every 2 years for women under 30.  Further it is advised that for most women over the age of 30 who have had 3 consecutive negative pap smears and no history of CIN2 or CIN3, that cytology screening be done once every 3 years.

Regardless of age, women who have had hysterectomies for benign conditions and without  a high-grade CIN, no longer need pap smears at all. 

According to Dr. Alan Waxman, the lead author from the University of New Mexico: a review of the evidence to date shows that screening at less frequent intervals prevents cervical cancer just as well, has decreased costs, and avoids unnecessary interventions that could be harmful”.

This statement is reminiscent of a policy that Medicare tried to institute over a decade ago when it issued a comment that a pap smear for seniors every three years was medically sound.  The reason for this was that even if a person were to develop cervical cancer, it would take more than three years before it became an invasive emergency.

The problem with that as is the problem now- when you tell patients that a smear every three years is acceptable, they interpret  it into  being no need to get an examination at all.  Not only that, three years becomes four or five or six or not at all once the habit of going to the gynecologist is gone.  Women will appear for examinations only when symptoms develop which can spell problems of epidemic proportions.

Self  breast examinations have been recently discouraged in the press.  Reports even insinuate that physicians’ breast examinations are ineffective as well. The entire structure of preventive care is being undermined.  This campaign seems more based on economics than on medical decisions.

What happens in a few years if we find that cancer rates are greatly increased?  Sure revisions can be made again as the pendulum swings the other way.  This certainly won’t help the ones that were hurt by the downturn of examinations.

 Until the test results  and examinations are done, we can all assume that we are healthy.  The new physician motto can then be …”No test, You’re Well”.

Healthcare Rationing vs. Sensible Approach: Embarking on a Perilous Journey

Healthcare reform has now become entangled in the latest controversy over whether affordable healthcare for all translates to healthcare rationing.

This week, the U.S. Preventive Services Task Force (USPSTF) issued its latest recommendations on screening for breast cancer, published in the November 17 issue of Annals of Internal Medicine.

New guidelines advise routine mammography screening for women starting at age 50 and repeated every two years until the age of 74, presuming there is no history of breast cancer in themselves or family.

No longer is the advisory panel recommending routine screening for women between the ages of 40-49.

According to the U.S. Census Bureau’s Population Division, its figures which were released on 5/14/09 reflects 10,761,793 women in this country between the ages of 40 and 44 with another 11,565,799 women between 45 and 49. So we are affecting quite a number of people.

The most startling is that the task force dissuades physicians from teaching women to do breast self-examinations because “ it leads to worry and stress”.

This is a drastic 180-degree turn from 2002 when the Task Force suggested mammography is performed every one to two years on women over 40 years. It is also in direct contradiction to guidelines issued from the American Cancer Society.

In the last several years, media along with the healthcare system had been very successful in promoting this message along with instruction on breast self-examinations with accompanying instructional literature and illustrated brochures.

Women are up in arms that with the government trying to reduce healthcare spending, that this step represents rationing of healthcare and that should individuals decide to have a mammography done, that insurance would no longer cover the procedure.

According to the USPSTF, the advice of the Task Force is not official or meant as Public Health Service guidelines or the basis for the U.S. Department of Health and Human Services. Kathleen Sebelius, the secretary of health and human services, confirmed this.

Statements issued from this panel have not only aided in stressing the importance of prevention in health care, but also have formed the foundation of the clinical standards for many professional societies, medical organizations and quality review groups.

Indeed, the White House insists that Task Force recommendations have no immediate bearing.

Insurance companies contacted by USA TODAY denied that annual mammograms would not be reimbursed and that despite new guidelines, will continue to cover the test for their insured.

Susan Pisano, a spokeswoman for America’s Health Insurance Plans, which include 1,300 companies, protecting 200 million Americans, stated that insurance plans have not proposed amending the coverage.

Representatives of the Society of Breast Imaging and the American College of Radiology also expressed concern that the new recommendations appeared to be issued for cost-saving measures.

Both the American Cancer Society and the American College of Obstetrics and Gynecology are still advising annual screenings beginning at age 40.

Yet despite protestations to the contrary, the National Cancer Institute stated that it would include the new recommendations to physicians and the public at large.

Government task force may be governing your health

Just this week, the nation was in an uproar over mammography recommendations put out by the USPSTF (U.S. Preventive Services Task Force.) The most widespread question was….

Who or What is the USPSTF and Will it Affect Me?

In an effort to create the best plan of action for primary care health providers, the Government formed an expert panel in 1984. Thus, the U.S. Preventive Services Task Force came to fruition.

USPSTF has a mission to assess benefits of health services based on age, sex and risk factors for illnesses and give advice about which of these preventive services, deemed most effective, should be implemented into primary care and looking at population statistics, which medical care is deemed most appropriate for specific populations.

The panel worked from 1984 to 1989 formulating guidelines based on a review of 2,400 published clinical research papers. The final report, which assessed clinical effectiveness of 169 preventive services including screenings, counseling, vaccinations and risk factor recommendations, was published in the Guide to Clinical Preventive Services.

In July 1990, the Department of Health and Human Services revisited the Task Force and reconvened the group to update the analysis of preventive services and to consider new evidence and new technologies which created the Guide to Clinical Preventive Services, 2nd Edition.

Since 1998, The Agency for Healthcare Research and Quality (AHRQ), which is the foremost group of private-sector authorities in primary care and prevention, sponsors the Task Force.

Although the Task Force is a Government-appointed panel, it is an independent advisory arm, which gives impartial evaluations of the scientific data, comprised of 10 members who are authorities in their fields of primary car (internal medicine, pediatrics, family medicine, gynecology, obstetrics, geriatrics, rehabilitation and nursing).

According to the USPSTF, the advice of the Task Force is not official or meant as Public Health Service guidelines or the basis for the U.S. Department of Health and Human Services.

Yet, statements issued from this panel have not only aided in stressing the importance of prevention in health care, but also have formed the foundation of the clinical standards for many professional societies, medical organizations and quality review groups.

Nine American Academies and Colleges of the various specialties partner with the USPSTF as does America’s Health Insurance Plans, AARP , the FDA, Medicare & Medicaid Services (CMS) and the CDC (centers for Disease Control and Prevention)

So, despite protestations to the contrary, it certainly seems based on statements issued by the Task Force, medical practice ( and most probably reimbursements of services) will indeed change.

The Government will be calling the shots!

Obama Pay-outs: You Foot the Bill

President Obama is proud to promote his healthcare bill which recently passed the House of Representatives.  Indeed, the President touts all the endorsements from organizations that he has gotten.  But these endorsements have been purchased- at YOUR expense.

Ever wonder why AARP endorsed the bill when seniors are going to get less services?

AARP writes Medi-gap insurance- a privately purchased expensive insurance coverage that pays for bills that Medicare does not cover.  Because of the price tag, most seniors opted for Medicare Advantage which decreased AARP profits.  All of a sudden President Obama states that this “cadillac” insurance will no longer be subsidized and must be eliminated, shifting more than ten million  elderly over to the more expensive Medigap which will see more profits.  AARP is smiling all the way to the bank.  Are you still wondering why AARP endorses Obama’s plan?

Big Pharma endorsed President Obama’s healthcare reform.  For this, the drug industry received guarantees that the government will keep cheaper Canadian sold drugs from being imported into the U.S.  A ten-year limit of $80 billion on cuts to prescription drugs also made its way to the forefront.

The AMA (American Medical Association) which incidentally does not represent the majority of physicians in this country, endorsed the President’s plan.  It turns out that physician’s Medicare reimbursements were facing 21% cuts which Obama promised to cut for endorsement.  Watch- now that he has gotten the endorsement, the cuts will come anyway!

The thing to remember is that “if you lie down with snakes, you will get bitten”!

What’s Next for the Healthcare Bill

Now that the House of Representatives has narrowly passed its healthcare legislation, everyone is looking to the Senate which has a vastly different view of the public insurance option including a state opt-out and income tax increase issues.  The Senate Health Committee also proposes to have the public insurance plan compete with private ones in the marketplace, negotiating rates with physicians and hospitals.

The Senate majority leader Harry Reid has a tough road ahead.  He must combine two versions of the senate health legislation- one from the finance committee- the other from the health committee. Cost analysis by the Congressional Budget office which is underway, is holding Mr. Reid back.  The only thing about the legislation that we do know is that there will be a public option plan in the mix.

The Senate includes a tax on the “Cadillac” insurance coverage while Democrats want to raise taxes on higher income citizens.

The next obstacle on  the legislative battlefield  is for the House and Senate versions to be merged into one prior to the final vote.

President Obama issued a statement thanking the House for passing the healthcare reform bill and reiterated his confidence that  the Senate will concur, saying “I look forward to signing comprehensive health insurance reform into law by the end of the year.”

Republicans are basically still not in sync with major points of the legislation.  Oklahoman Republican Tom Coburn is threatening to have all 2,000 pages of the bill to be read aloud on the Senate floor.  Under Senate rules, this could not be stopped.

As opposed to the House bill, at least this way we know that the Senators would have read or be familiar with all the proposals on these pages!

New healthcare Legislation Narrowly Passed- Now passing it by You

By a margin of only 5 votes, the U.S. House of Representatives passed new legislation for overhauling the American healthcare system.  

Requirements of the $1.3 trillion-dollar bill includes:

  • individuals must buy health insurance
  • medium and large businesses must provide insurance to their employees
  • low and middle-income families could receive subsidies to buy their insurance
  • insurance companies would be mandated to provide coverage to individuals regardless of pre-existing conditions
  • insurance companies can not drop individuals who acquire medical problems or cost of care
  • Individuals would purchase their insurance from a list of companies which includes a public option on the list. 
Shortly after the vote, President Obama stated “Tonight, in an historic vote, the House of Representatives passed a bill that would finally make real the promise of quality, affordable healthcare for the American people”.
House Speaker Nancy Pelosi from California stated “When we can’t find common ground, we have to stand our ground”.
But democrats did not in fact stand their ground.  In order to make the proposal more palatable, a stipulation was made that insurance companies that offer financial coverage for abortions, would not be eligible for the insurance company list that patients can choose from.
This is quite frightening.  The point is not about abortion.  The fact is that legislators are deciding what treatment options will be made available  “for the good of the public”.  What treatment option will be eliminated next for the “cause” and “financial consideration”?
Rep. Joe Barton, a Republican from Texas remarked “I just don’t think it’s right that in the guise of helping Americans, we’re telling Americans what they have to do”.
Representative Diana DeGette from Colorado remarked  “To say that this amendment is a wolf in sheep’s clothing would be the understatement of a lifetime.  If enacted, this will be the greatest restriction on a woman’s right to choose in our careers.”
Republicans voiced their concern that the bill would catapult the national deficit and give the government a larger and improper role in American’s healthcare decisions.
And so it has begun! 
 

Government Swaps Citizens

The U.S. government is swapping citizens!

Sounds bizarre?

Congressman King in Massapequa Park, New York met with local AARP members to discuss healthcare reform. During this meeting, Mr. King confirmed what most seniors knew or suspected.

President Obama addressed Congress on September 9th and unfolded his plan to cut Medicare by $500 billion.  Under this plan H.R. 3200, $156 billion will be taken from Medicare Advantage. This will cause 3 million seniors to lose their current plan due to companies either dropping the Medicare Advantage  or raising premiums to rates that seniors could not afford.  This represents almost 20% of senior coverage.

Medicare Advantage protect seniors from high out-of-pocket expenses as well as vision and dental coverage and the free preventative screenings that regular Medicare does not cover.

Let’s look at the problem honestly.  Dropping programs will be covering real people at a time when coverage is needed most.

So, here’s the thing.  In order to insure a segment of the population that is currently not covered, the government is willing to drop insurance for another segment of the population- a swap of people.

Medicare Physician Payments Affect You as well as your M.D.

Chuck Hagel, the former Nebraskan senator writes “Congress and the administration are working on bipartisan practical solutions to improve our health care system.  I urge all members of Congress to put aside their narrow partisan differences and seize this moment for health care reform”.

Contrary to what this statement would have you believe, as indeed most Democrats would have you believe, this is not a bipartisan proposal.  There are no Republicans in favor of the proposals to date except for Maine’s senator Olympia Snowe who states that although she is considering the bill, she has not yet decided.

Members of the Senate finance committee state that the bill entices patients to use generic drugs by waiving the initial co-payment for those wishing to try them.  Not being new, this is reminiscent of the law passed more than 5 years ago where physicians had to sign dispensed as written for medication and if that was missing, the pharmacists were obligated to give patients the cheaper generic drug.

The most disturbing is the following:

The U.S. House of Representatives plans to take up a bill, the “Medicare Physician Payment Reform Act of 2009” (H.R. 3961), to stop the 21 percent Medicare physician payment cut that is coming on Jan. 1, 2010. 

The Medicare cuts for doctors that will take effect in less than two months are a major problem for you and your family because they will prevent many doctors from accepting new Medicare patients, discourage some from investing in new health technology, and make many think about closing their medical practices altogether!

Now is a time to take action and call your Congressmen.  They must say NO to the proposals.

Health Insurance Companies need Compassion, but So Do We

A timely topic appeared as a docu-drama last night on Law and Order and was viewed by millions.

As desperate parents sought treatment for their only child who was diagnosed with leukemia, we watched the process of rejection that the insurance companies sometimes make for healthcare coverage.

Rather than approve a drug recently out on the market that did not have long term studies and would cost millions of dollars, the insurance company approved a bone marrow transplant.  We then learn that since the little girl is Hispanic, chances of her finding a suitable donor for the transplant were remote.

The reasons given by the decision makers in the insurance company were supposedly because the bone marrow transplant was a proven treatment and would be cost effective.  Further, that approving the untested drug might bankrupt the insurance company and that the company had an obligation to the rest of the insured community to ensure that it would be around and solvent to insure others in their time of need.

Because the decision maker stood in the way of a possible cure for the child in the eyes of the father, Mr. Insurance Man was murdered.  At the trial, the defense was the taking of a life was justified to save another.

The problem with this logic is obvious.  No one is safe if making decisions puts us in jeopardy of being murdered or harmed.  Everyone makes someone angry at some point, even when the decisions are educated and justified in our minds.

What makes this drama especially disturbing is that the father was not found guilty.  It seems that the sentiments against health insurance companies are popular ones and that the insurance companies are comprised of very sinister people, plotting against the public for their own financial gain.

In other words, in order to force humanity onto the insurance companies, we are becoming less human.  This cannot be acceptable and yet for many it is.

What are your thoughts?