Last week, a government-sponsored task force presented new recommendations regarding breast self examination and mammography.  The Task Force recommended the complete abandonment of breast self-exam by women.  They also advised that, in general, mammography not be done until age 50, and then on a biannual basis.  Currently, mammography is done annually after age 40. If these recommendations are followed by the federal government and by insurance companies, they will result in substantial healthcare savings for the nation.  However, the cost will be that thousands of women will have their breast cancer diagnosed at a later date. While this may not matter in women with slow growing tumors, women with fast growing tumors will be less likely to survive.   In the judgement of the committee,  the resultant loss of life will be justified by the savings from, what they describe as,  "a more efficient" system.

This is one great example of why you do not want the government dictating health care policy.  Even though the committee is composed of physicians, they were all appointed by government funded agency. When the government dictates policy, there will always be a tendency to place a value on a life, as was done in this report.  The committee even acknowledged that if the purpose of the health care system was to save lives, their recommendations would be unnecessary.  They are only trying to make the system "efficient," which is a modern term for rationing.

These recommendations are particularly offensive because they are partially based on "models" that try to predict the consequences of their proposed changes.  This is in contrast to a scientific study where changes are made to a small group and those patients are followed to determine the impact of the changes.  Health care models are as fallible as economic models, as they are based on numerous assumptions.  Just as bad economic predictions have had adverse effects on our economy, so could bad health care models adversely impact thousands of women.

While using models may be bad, the task force made use of some questionable studies to form their opinions. One of the studies used to support stopping breast self exams involved a poorly-controlled trial of Russian women whose overall survival was much worse than is seen in the US. What that means is that the study is probably not applicable to American women. A conservative approach would be to duplicate the study in the US before changing recommendations about something so serious.

There is no question that trying to find breast cancer early is difficult and expensive.  However, the process becomes ridiculously expensive because of medical liability concerns.  As the committee pointed out, the majority of tests done following an abnormal mammogram fail to demonstrate breast cancer.  These test are an example of defensive medicine, practiced by many doctors doing mammography. Since a delay in diagnosis is a leading cause of medical liability claims,  doctors are forced to order extensive testing to prove that any abnormality on a mammogram does not represent cancer.  Being right 99% of the time is not good enough, as the one missed cancer can result in a multi-million dollar law suit. Being perfect in mammography is very expensive.

Unfortunately, instead of addressing the problem of tort reform as it impacts breast cancer detection, the government's committee has chosen to advise everyone to just bury their heads in the sand and hope nothing happens.  A reasonable compromise would be to free physicians from the fears of ruinous lawsuits  and continue with the present mammography recommendations. With proper tort reform, physicians could still detect breast cancer early without wasting billions of dollars ordering unnecessary tests. Thousands of women would be saved along with billions of dollars.

My current advice to patients is to ignore these new recommendations until there is more scientific data to support them. The Mayo Clinic and the Baylor College of Medicine have taken a similar stance. Women should continue to get yearly mammograms beginning at age 40; some women with certain risk factors should begin sooner. All women over the age of 20 should do monthly breast self examinations and should report abnormal findings to their doctor.

Breast cancer remains a common and potentially lethal form of cancer that affects about 1 in 8 women. Since survival is clearly improved by early detection, I feel women should continue to do everything to try and detect breast cancer as early as possible.