Republicans warn that rationing has begun

Almost no issue is more emotional than health and almost no health issue is more emotional than breast cancer. So the firestorm of hostility in the US in response to advice from the Federal government that women delay routine mammograms until they are 50, rather than 40 was hardly surprising. Women aged 50 to 74 should be screened every other year, rather than every year.

The new breast cancer screening guidelines coincided with new guidelines about cervical cancer which also recommended less testing. The American College of Obstetricians and Gynecologists issued revised recommendations this week for Pap smears. It said that young women should begin getting the test at a later age and at less frequent intervals than previously recommended.

Politically, the timing was terrible. Obamacare is being bombarded with criticism over putting dollars above human lives. Republicans used the visceral reaction to breast cancer as a political opportunity. “This is how rationing begins. This is the little toe in the edge of the water,” thundered Republican Congresswoman Marsha Blackburn, of Tennessee. “This is when you start getting a bureaucrat between you and your physician. This is what we have warned about.” And Sarah Palin’s inner feminist popped up on her Facebook page: “why [are] these women-focused cancers … seemingly receiving substandard attention at a time when proactive health and fitness should be the message”?

Although the breast cancer recommendations of the Preventive Services Task Force did not consider the cost of screening, delaying it for 10 years will certainly save insurance companies money. But, apparently, it is a win-win situation because it is largely ineffective. However counterintuitive it may seem, the large number of false positives from the tests and consequent anxiety and extra biopsies are actually counterproductive if younger women are tested.

Research has shown that one cancer death is prevented for every 1,904 women aged 40 to 49 who are screened for 10 years, compared with one death for every 1,339 women from 50 to 74, and one death for every 377 women from 60 to 69.

Unfortunately, whatever the facts may be, for decades doctors have told responsible, health-conscious women to have annual tests once they reach 40. Now it is nearly impossible to convince bewildered women and their families that more testing will not make them healthier.

Secretary of Health Kathleen Sibelius quickly distanced herself from the report. “The task force has presented some new evidence for consideration but our policies remain unchanged,” she said. “Indeed, I would be very surprised if any private insurance company changed its mammography coverage decisions as a result of this action.”

New York Times journalist Kevin Sack summed up the controversy as succinctly as any of the commentators: “This week, the science of medicine bumped up against the foundations of American medical consumerism: that more is better, that saving a life is worth any sacrifice, that health care is a birthright.” ~ New York Times, Nov 20;

Michael Cook

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Michael Cook

Michael Cook edits BioEdge, a bioethics newsletter, and MercatorNet, an on-line magazine whose focus is human dignity. He writes from Sydney, Australia.

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