Monday, November 23, 2009


The current mammogram controversy is yet another example of ignorant, unthinking people going crazy about something they don't understand. Most critics of the new U.S. Preventive Services Task Force guideline do not understand that our system has finite resources. They also don't understand that there is no such thing as saving a life. There is only delaying death. Also not mentioned in any of the articles I am reading is that breast cancer mortality rates are usually only measured for five years.

The new guideline says that the recommendation for mammograms should be once every two years starting at age 50. This replaces the recommendation for annual mammograms starting at 40. They found that only 1 in 1900 mammograms for women in their 40s delayed death. This may save $2 billion per year and result in maybe 600 undelayed deaths. That means the old guideline resulted in spending about $3.3 million dollars per delayed death. I don't know the life expectancy of breast cancer survivors, but for the sake of more math, let's say that all of these deaths were delayed by 40 years. That's over $83,000 dollars per year of life, just spent on mammograms! Keep in mind that these women will continue to incur more health care costs over those 40 hypothetical years, too, and I am not considering quality of life.

The British system refuses to pay for drugs that cost more than $45,000 per quality-adjusted life year (QALY). Medicare limits hospice spending to about $22,000 per year (if I read that right). These measures are necessary to protect the whole system from going bankrupt, as our system is destined to by 2017 unless we make drastic changes. These measures also help ensure that the system's finite resources are being used where they can do the most good.

Think about how much good could be done with that $2 billion per year. I guarantee that we could save far more than the breast cancer's 24,000 (my certainly too-high hypothetical estimation) life-years by spending it somewhere else. I bet that $2 billion could be easily spent to save 100,000 life-years or more. Critics of the new guidelines are selfish and short-sighted, and would rather hang on to their anecdotes of women whose deaths were delayed while sentencing thousands of other people to a lack of care due to insufficient resources. These costs also keep insurance premiums high, pricing working poor out of comprehensive insurance.

Women considered high risk due would still be recommended for mammograms before 50. There is some talk about how black women would be disadvantaged by the new guideline because they tend to have earlier and more aggressive cancers, and of course that would be taken into account by informed doctors making recommendations. The task force guideline is based on aggregate information for the national population.

Mammograms have been oversold, and our country as a whole would be better off following the new guidelines. We need to make our entire system more efficient and cost effective (not the same as cutting the total cost, just demanding better results for our money) for it to be sustainable and good for the people of our country.

Reblog this post [with Zemanta]

No comments:

Post a Comment