The U.S. Preventive Services Task Force has issued new recommendations that routine screenings for breast cancer should be done only every two years rather than annually, and starting at age 50 rather than 40 for most women. To the layman, this seems like news to be welcomed. Reduced frequency of a painful and dreaded screening, with no difference in health outcomes for most patients? What's not to like? And indeed, some experts have already applauded these findings. On the other hand, very quickly after the announcement, other voices were raised in a chorus of protest. Those early negative reactions seem baseless.
First, the recommendations don't mean "doing away with screening," as one radiology professor complained. In fact the PSTF's spokesman was at pains to point out the changes relate only to routine screening. As with other diseases, a patient's history, doctor's advice, and other factors will continue to determine when the "standard" recommendations need to be ignored. So it seems self-evident that some patients, who might need or want screening earlier than age 50, based on self-examinations, or on a doctor's recommendation, or even just a preference, will obtain it.
Second, the reasons provided for changing the "rules" seem rational: Data suggest that more is lost under current norms (once a year after 40) in anxiety, false positives, and needless costly/painful procedures, than is gained by the screenings. In this respect, breast cancer and prostate cancer are similar. The real message here is that current screening tests for both diseases really don't work very well, and need improvement.
Third, I don't see politics in the situation. Some have professed to see the PSTF's announcement, coming from a government agency, no less, as a harbinger of "denial of care" or "rationing" that's in store for us under health reform legislation. But to me, that's seriously paranoid. You can believe that the government is plotting to ration care and would make that public before any legislation is passed, or you could choose the more likely conclusion that only those opposing health care changes might hope to benefit from announcing these changes now. In fact, making this announcement before reform bills are passed strongly suggests that the changes are proposed for sound health reasons.
Last, a word about cost. Some who bemoan the changed recommendations worry that insurance companies might refuse to pay for any screening before age 40. Undoubtedly that's at least a possibility. But this complaint also reflects the distorted nature of "cost" perceptions in our health care system. Existing bills, as many experts have pointed out, may result in more people being insured, or in fewer abuses of policy coverage, but they don't truly deal with the rising costs of most health care. Here's a case where things do need to change. When all care is essentially free (ie. covered by insurance), the consumer has no incentive to worry about the cost of what he "wants." If consumers were focused on costs, a switch that would reduce the frequency of an expensive screening by half would be a no-brainer. That's the next, and bigger task, for health care reformers.
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