The Road To 100

Wendi Baron-Willette died at the age of 45.

I wrote a farewell to Wendi on my blog on October 22.  Now, just four weeks later, the U.S. Preventive Services Task Force (USPSTF) has released new government recommendations for breast cancer detection.  The recommendations now state that women should not begin regular mammogram screenings until the age of fifty, and that even then women should have mammograms every two years rather than the yearly exams previously recommended.  The long-standing practice of women performing breast self exams is also no longer to be practiced.  Needless to say, these recommendations have people very upset and rightly so.

First, what is the USPSTF?  From the USPSTF web site:

The U.S. Preventive Services Task Force (USPSTF), first convened by the U.S. Public Health Service in 1984, and since 1998 sponsored by the Agency for Healthcare Research and Quality (AHRQ), is the leading independent panel of private-sector experts in prevention and primary care. The USPSTF conducts rigorous, impartial assessments of the scientific evidence for the effectiveness of a broad range of clinical preventive services, including screening, counseling, and preventive medications. Its recommendations are considered the “gold standard” for clinical preventive services.

The mission of the USPSTF is to evaluate the benefits of individual services based on age, gender, and risk factors for disease; make recommendations about which preventive services should be incorporated routinely into primary medical care and for which populations; and identify a research agenda for clinical preventive care.  (emphasis added)

In a nutshell this is the panel that doctors often use to guide their recommendations for their patients and insurance companies use to determine coverage plans.  A medical think tank upon whom professionals in the medical fields rely.  This is the same group who in 2002 wrote, “For women aged 40-49 … some experts recommend annual mammography based on the lower sensitivity of the test and on evidence that tumors grow more rapidly in this age group.”

Apparently the USPSTF now believes they were mistaken in 2002.  There are others who believe they are mistaken in 2009.  Both the American Cancer Society and Breastcancer.org are disagreeing with the panel’s conclusions.  Basically, the USPSTF is stating that the number of false positives causes too many unnecessary procedures and undue mental anguish.  The ACS and breastcancer.org argue that undue mental anguish and unnecessary procedures are small prices to pay to save lives.  The USPSTF also is charged to look at data from a public health perspective.  As breastcancer.org reports, this means the panel looked at how changing the screening guidelines would affect the overall public, not individual women.

OK.  What is the bottom line here?  From the American Cancer Society web site:

“The USPSTF says that screening 1,339 women in their 50s to save one life makes screening worthwhile in that age group. Yet USPSTF also says screening 1,904 women ages 40 to 49 in order to save one life is not worthwhile. The American Cancer Society feels that in both cases, the lifesaving benefits of screening outweigh any potential harms. Surveys of women show that they are aware of these limitations, and also place high value on detecting breast cancer early.

“With its new recommendations, the USPSTF is essentially telling women that mammography at age 40 to 49 saves lives; just not enough of them. The task force says screening women in their 40s would reduce their risk of death from breast cancer by 15 percent, just as it does for women in their 50s. But because women in their 40s are at lower risk of the disease than women 50 and above, the USPSTF says the actual number of lives saved is not enough to recommend widespread screening. The most recent data show us that approximately 17 percent of breast cancer deaths occurred in women who were diagnosed in their 40s, and 22 percent occurred in women diagnosed in their 50s.”

The bottom line is that screening women in their forties isn’t cost efficient.  As I wrote on October 19 in this blog, health care rationing is on its way, and this is just another example of what to expect.  We need to understand that with health care costs rising at a ridiculous rate every year, more and more procedures will be looked at through the cost/benefit microscope.    Who decides how the cost/benefit analysis will be determined?  Right now it is Kathleen Sebelius, the secretary of health and human services.  She followed up the panel’s recommendations by saying the new guidelines won’t change federal coverage of mammograms.  She said the panel “does not set the federal policy, and they don’t determine what services are covered by the federal government.”  This is reassuring, for now.

What if health care costs continue to rise and the cost/benefit model needs to change?  What if a new secretary of health and human services determines that federal policy should follow the “gold standard” of recommendations?  Then it comes down to one question; What is the value of saving one out of every 1,904 women in their forties?  I’ll bet this question has two answers.  There is the answer looked at from a public health perspective.  Then, there is the answer if the woman we are discussing is your wife, your mother, your daughter, or you.

Wendi Baron-Willette died at the age of 45.  Just two years prior she was diagnosed with breast cancer.  The USPSTF now believes their recommendations from 2002 were wrong.  My questions is…

What if they are wrong in 2009?