Wednesday, November 18, 2009

On the new breast cancer screening recs

Here we go again. I think the NY Times Prescriptions blog put it best: “Call it death panel redux.”

On the heels of the breast cancer recommendations this week, congressional Republicans are saying it’s healthcare rationing. “This is what happens when bureaucrats make your healthcare decisions,” Rep. Dave Camp of Michigan said, according to the Times.

Never mind that the recommendations — to begin routine screenings at 50 rather than 40 and to stop monthly self-exams — are unenforceable and nonbinding for doctors or insurers.
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Never mind that it was not the government making the recommendations, but an independent task force of experts. Never mind the recommendations had nothing to do with the healthcare reform bills in Congress.

Camp and others are saying it’s foreshadowing the role government would play in regulating insurance coverage under the House healthcare bill. He said: “Agencies will be created that will make decisions like this, that some lifesaving screening is not worth it.”

Am I the only one who thinks this sounds like another truth-bender meant to freak people out? From what I have read, many women are already confused and concerned about the recommendation. (Particularly I am hearing from some women at high-risk that they worry they will be denied screening.)

I tend to agree with KevinMD’s blog post on the topic. He writes that the guidelines are a good move, and acknowledge the downside of cancer screening. “In other words, evidence has been introduced into the guidelines, resulting in the recommendation for less testing.”

But because the evidence says less rather than more, some say it’s denying or rationing care. Kevin continues, “The thought that ‘more medicine is better testing’ is so pervasive in the mindset of the American public that it’s going to be extremely difficult to scale back testing in this country. Even if it’s the right thing to do.”

Indeed, many docs are saying they won’t follow the guidelines, in part because their patients wouldn’t understand the risk-benefit analysis on which the recommendations are based. So any efforts for evidence-based medicine will certainly take serious education and outreach for doctors and patients alike.

I would be interested to hear from you on how you plan to approach the guidelines in practice and with your patients.

1 comment:

  1. I was called "old school" by a diabetic educator because I told a new type II diabetic not to test his sugars at home. In fact, I am "evidence-based cutting edge" because randomized trials have shown that home monitoring does not improve diabetic control but does increase depression.
    As with these breast cancer screening guidelines, emotional responses to disease should not overrule the evidence.
    I plan to carefully review the guidelines and discuss them with my patients and together we will make a decision that is both evidence-based and individualized.