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Mammograms- New Govt Guidelines - Can't Believe!

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lady4law View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote lady4law Quote  Post ReplyReply Direct Link To This Post Posted: Dec 09 2009 at 12:57am
Mainsailset
Yes the State will no longer be paying for mammos.

Re: PAP smears, within days of the new "view" of no mammos for those under 50, as they cause un-needed biopsies, another "reliable" study/source is claiming the same for PAPs for those under 50.

Re: CT and PETs -claims have been out for a few months, stating they are of no help in saving women's lives. (In fact I believe there is a separate section here,  regarding PET/CT). I was so upset after reading it, I planed to never return to this site. A very good friend of mine is alive today, because a PET scan showed her BC had returned. If she did not have that scan, she would have been dead 4 years ago. The same is true of my mom. She lived an additional 20 years after being DX with BC, ONLY because, 1st mammos, then after her second mast, PET and/or CTs caught mets 3 times, each time allowing her an additional 5-6 years. WIthout these testing measures, mom would have died 15 years earlier. Not seeing the mets means no treatment, and death.
Jean
IBC/TN 6/07 Lymph, Chemo, Mast w/rec, chemo, 2 infect surg, exchg (2x) redo rec (2x) 4 new tumors esophagus, colon, chest, mouth, (10/11- 5th SUV7)"Activity" in spine hip
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Post Options Post Options   Thanks (0) Thanks(0)   Quote SagePatientAdvocates Quote  Post ReplyReply Direct Link To This Post Posted: Dec 09 2009 at 1:27am
Dear Captain,

I am sorry you have need to be here and I wish your wife a successful battle. Welcome to this wonderful resource.

I am a huge Dr. Winer fan. I think he is a brilliant researcher/physician, yet has stayed a mensch (my highest compliment). He has been very open when we have talked and I am looking forward to seeing him again in San Antonio at the Breast Cancer Symposium. Please understand, all, I do not have a close relationship with him but he makes me feel extraordinarily comfortable talking with him.

Captain, your decision to re-locate to be close to Dana Farber, I feel, was an excellent one.

Dr. Winer's views on the mammography controversy were summed up in an email that I received from the Komen organization. Dr. Winer is the Chief Scientific Advisor to Komen and also plays a role on the TNBCFoundation's scientific advisory board.

I believe I posted this earlier on this thread but I am too tired to try and find it so here goes again...



SUSAN G. KOMEN FOR THE CURE® RECOMMENDS NO IMPEDIMENTS
TO BREAST CANCER SCREENING

 

Until Science Improves, Current Screening Recommendations Should Remain, Worlds Leading Breast Cancer Organization Reports

 

DALLAS  Nov. 16, 2009  Susan G. Komen for the Cure®, the worlds leading breast cancer advocacy organization, has carefully reviewed the data and new recommendations from the U.S. Preventive Services Task Force (USPSTF) concerning mammography screening. Komen for the Cure issued the following statement today from Eric P. Winer, M.D., chief scientific advisor and chair of Komens Scientific Advisory Board.

 

Susan G. Komen for the Cure wants to eliminate any impediments to regular mammography screening for women age 40 and olderWhile there is no question that mammograms save lives for women over 50 and women 40–49, there is enough uncertainty about the age at which mammography should begin and the frequency of screening that we would not want to see a change in policy for screening mammography at this time. Komen’s current screening guidelines can be found atwww.komen.org and would not be changed without serious consideration.

 

Our real focus, however, should be on the fact that one-third of the women who qualify for screening under today’s guidelines are not being screened due to lack of access, education or awareness. That issue needs focus and attention: if we can make progress with screening in vulnerable populations, we could make more progress in the fight against breast cancer.

 

Mammography is not perfect, but is still our best tool for early detection and successful treatment of this disease. New screening approaches and more individualized recommendations for breast cancer screening are urgently needed. Susan G. Komen for the Cure is currently funding research initiatives designed to improve screening, and we believe that it is imperative that this research move forward rapidly. Komen also provides funding for more than 1,900 education, awareness and screening programs.

 

We encourage women to be aware of their breast health, understand their risks, and continue to follow existing recommendations for routine screenings including mammography beginning at age 40.”

 

A more detailed explanation of Komen’s position follows:

 

 

 

From the Susan G. Komen for the Cure Scientific Advisory Board Regarding U.S. Preventive Services Task Force (USPSTF) Recommendations on Breast Screening

Nov. 16, 2009

 

There has been a longstanding debate over the most appropriate age to begin mammography screening and the frequency of screening examinations. As with all screening tests, the decision to perform a mammogram must include an evaluation of the benefits and the risks of the screening tool, as well as a consideration of patient preference. 

 

The recent controversy about mammography should not suggest that there is debate about the most important issues. Most breast cancer experts agree far more than they disagree. For example, there is no debate that mammography reduces the risk of dying from breast cancer. As stated in the new USPSTF recommendations, extensive scientific evidence demonstrates that mammography reduces breast cancer mortality both among women aged 50 and older, as well as among women aged 40 to 49. 

 

Because breast cancer false positive results are more common in women under 50, some argue for a different screening approach in women 40-49 than in those over 50. The USPSTF suggests that women 40-49 consider their individual risk of developing breast cancer before making a decision about screening mammography. They further suggest that those women at increased risk should strongly consider regular mammography screening. Women at lower risk, who wish to initiate screening in their 40s should recognize that the benefits of screening are less than in older women. 

 

As to the timing of mammography, the USPSTF also suggests that screening every other year is likely to be as effective as annual screening, and that this approach would decrease false positives. Biennial screening is already practiced in many countries. Different organizations, based on a review of the same data, may recommend either yearly or every other year screening for women at average risk of breast cancer between the ages of 40-75. We believe that the timing of assessment is best left to a woman and her health care provider. We call upon third party payers to fund annual mammography if a woman and her health care provider opt for this approach. There are no studies that directly address the role of mammography in women over the age of 75. We recommend that older women, particularly those in excellent health, discuss the role of ongoing screening with their health care provider.  

 

One-third of all American women do not undergo regular screening. The failure of age appropriate women to undergo mammography costs lives and reflects problems with access to care and breast cancer education. We need to work as rapidly as possible to correct these deficiencies, and Susan G.  Komen for the Cure continues to fund research and education designed to eliminate health care disparities. 

 

We want to eliminate any impediments to regular mammography screening for women age 40 and older. It is our view, however, that the exact timing of assessments is less important than guaranteeing access to screening. New screening approaches and more individualized recommendations for breast cancer screening are urgently needed. Susan G. Komen for the Cure supports research initiatives designed to improve screening, and we believe that it is imperative that this research move forward rapidly. 

 

As a breast cancer community, we must all recognize that both breast cancer screening and breast cancer treatment are moving targets. As treatment continues to evolve in the years ahead, these changes may have an impact on the optimal approaches to screening as well. 

 

In the meantime, honest differences in opinion can and do exist, and such differences represent attempts on the part of individuals and/or organizations to provide the best possible care to women of all ages and to minimize mortality and suffering from breast cancer. We encourage women with unresolved questions about breast cancer screening to engage in discussion with their health care providers."


........


again welcome and please say hi to your wife from all of us...we are all rooting for her..


all the best,


Steve





I am a BRCA1+ grandson, son and father of women affected by breast/oc-my daughter inherited mutation from me, and at 36, was dx 2004 TNBC I am a volunteer patient advocate with SAGE Patient Advocates
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Post Options Post Options   Thanks (0) Thanks(0)   Quote mainsailset Quote  Post ReplyReply Direct Link To This Post Posted: Dec 09 2009 at 11:42am
Jean, I was hoping for a link on your information, I did find a link on the CA funded mammos which makes the case that this is a decision based on CA's failing economy, made even before the panel came out with its results but certainly it points out to State's with failing economies who are cutting every cost they can, that the panel's recommendations gave a green light to state budget offices.
I haven't looked yet for links on the other info you gave, but will post when I find. The reality is that state budgets are cutting across the board and the quality of life, medical care & employment are all going out the window.
Best, M
 
update:  I don't seem to be able to find anything more on denial of the PET/CT scans other than the discussions here about individual insurance companies denying payment as an ongoing company stance. Which stinks. But Google didn't come up with any articles on this nor did the Search button here at the site.
 


Edited by mainsailset - Dec 09 2009 at 11:54am
dx 7/08 TN 14x6.5x5.5 cm tumor

3 Lymph nodes involved, Taxol/Sunitab+AC, 5/09 dbl masectomy, path 2mm tumor removed, lymphs all clear, RAD 32 finished 9/11/09. 9/28 CT clear 10/18/10 CT clear
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Post Options Post Options   Thanks (0) Thanks(0)   Quote mainsailset Quote  Post ReplyReply Direct Link To This Post Posted: Dec 13 2009 at 11:48am
A new discussion from the standpoint of a breast surgeon which makes some interesting points that the panel was not taking into account TNBC and black women in their recommendations. There's also some good links in it, scroll bout half way down to the paragraphy that starts "Unfortunately ...."
 
dx 7/08 TN 14x6.5x5.5 cm tumor

3 Lymph nodes involved, Taxol/Sunitab+AC, 5/09 dbl masectomy, path 2mm tumor removed, lymphs all clear, RAD 32 finished 9/11/09. 9/28 CT clear 10/18/10 CT clear
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Post Options Post Options   Thanks (0) Thanks(0)   Quote gpawelski Quote  Post ReplyReply Direct Link To This Post Posted: Jan 13 2010 at 1:49pm
Follow the mammogram money

Wall Street Journal's Alicia Mundy reported that the final health care bill in Congress is likely to require coverage for more mammagrams than the USPSTF recommended after women's groups, doctors and imaging equipment makers stepped up pressure on lawmakers.

From the article:

Adriane Fugh-Berman, a professor at Georgetown University's medical school in Washington, D.C., said the evidence supports less-frequent mammograms. "You have to ask if there's conflict of interest, because breast-cancer advocacy has become a big business," she said.

Ties between nonprofits and companies have been under attack by some consumer watchdogs. Sen. Chuck Grassley, an Iowa Republican, sent letters last month asking 33 major nonprofit groups including the American Cancer Society to disclose their industry funding.

The American Cancer Society said it has received less than $1 million from screening-device makers in the past five years. Its spokesman said the donations, which are small relative to the society's annual revenue of more than $1 billion, don't influence its recommendations.

The American College of Radiology, a trade group, called the new government guidelines scientifically unfounded, and said that if the guidelines are adopted, "two decades of decline in breast-cancer mortality could be reversed and countless American women may die needlessly."

Its flagship research program studies the role of radiology in medicine. It received donations of at least $1 million each from General Electric Co.'s GE Healthcare and Siemens AG, according to the trade group's 2007-08 annual report. Both companies make mammography equipment and MRI scanners. Several other medical-device makers donated at least $100,000.

A spokesman for GE said the new guidelines conflict with successful early-screening programs. A representative of Siemens didn't respond to a request for comment. The college of radiology said sponsors haven't influenced its research. It has spent $480,000 on lobbying in the past two years, while the imaging industry spent more than $2.5 million.

One of the largest breast-cancer-awareness groups, Susan G. Komen for the Cure, has worked with GE and other companies. Komen turned to GE in October when it lit the Great Pyramids pink to mark a major screening initiative in Egypt. Neither GE nor the Komen group would say how much the event cost.

In 2007, GE sold limited-edition pink cameras to Home Shopping Network, which donated a portion of the sales to Komen. Imaging and film companies whose products go into mammography equipment have made pink DVD players, pink computer flash drives and pink cellphones, a portion of whose sales raise money for Komen and other breast-cancer groups.

In events at the Capitol, Komen for the Cure founder Nancy Brinker has praised GE's digital mammography technology, and she received a public-service award from the company.

Ms. Brinker, sister of the late Susan G. Komen, said some patient-advocacy groups tended to represent industry views, but her organization's push has always been early detection.

A traveling mammogram van purchased this fall by the American Cancer Society, Komen and other advocacy groups for the Dana-Farber Cancer Institute in Boston touts a new GE Healthcare Senographe Essential digital-mammography system.

A lobbying group leading the charge in Washington against the new guidelines is the Access to Medical Imaging Coalition, whose members include GE and Siemens and several nonprofit patient groups, the college of radiology and leading doctors societies.

The coalition's director, Tim Trysla, is a lobbyist at a Washington law firm. He has been working in Congress against proposals to cut billions of dollars in Medicare spending in the health-overhaul bill that could hurt imaging-device makers.
 
Gregory D. Pawelski
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Post Options Post Options   Thanks (0) Thanks(0)   Quote gpawelski Quote  Post ReplyReply Direct Link To This Post Posted: Jan 13 2010 at 1:50pm

The storm that greeted the USPSTF guidelines on mammography screening for women in their 40s prompted the Senate to insert a mandate in its health care reform bill that every insurer cover every mammography screening test at no cost to beneficiaries.

The Journal of the American Medical Association (JAMA) published an article, "The Benefits and Harms of Mammography Screening: Understanding the Trade-offs," reminding physicians and women about the serious health costs of adopting that policy.

The authors, Dartmouth's Steven Woloshin and Lisa Schwartz, used the "number needed to treat" analysis to point out:

Without screening, 3.5 of 1000 women in their 40s will die of breast cancer over the next 10 years (ie, 996.5 of 1000 will not die of the disease).

Screening reduces the chance of breast cancer death from 3.5 to about 3 of 1000. In other words, 2000 women between 40 and 49 must be screened annually for the following ten years to save one life.

For most women with cancer, screening generally does not change the ultimate outcome; the cancer usually is just as treatable or just as deadly regardless of screening.

Finding cancers that were never destined to cause symptoms or result in death is the biggest problem with mammography, especially among younger women. Since it is impossible to know which cancers caught early are benign, all are treated with surgery, chemotherapy, radiation, or some combination. Overdiagnosed women undergo treatment that can only cause harm, and must live with the ongoing fear of cancer recurrence.

While only 7% of women believe there could be breast cancers that grow so slowly that leaving them alone would not affect their health, randomized clinical trials have consistently shown that the groups undergoing mammography have more breast cancer, even after 15 years of follow-up. This persistent difference represents overdiagnosis.

Estimates of the rate of overdiagnosis range from 2 women overdiagnosed for every breast cancer death avoided in one trial, to 10 to 1 in another.

Woloshin and Schwartz concluded: "The politicalization of medical care is wrong. Promoting screening irrespective of the evidence may garner votes but will not create healthier voters. People need balanced information. Simplistic slogans touting only the benefit are deceptive. Simple, standardized summaries about the benefits and harms of testing would help foster good decision making."

Gregory D. Pawelski
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Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Jan 13 2010 at 8:41pm
Originally posted by gpawelski gpawelski wrote:

Screening reduces the chance of breast cancer death from 3.5 to about 3 of 1000. In other words, 2000 women between 40 and 49 must be screened annually for the following ten years to save one life.


Gregory,

Are you telling me that it costs too much to screen 2,000 women to save one life?  Well I was the one life out of 2000 that was saved as a result of a mammogram.  I am not a statistic.  It's easy to rant and rave about this, but if it was your life, I'm sure your opinion would change drastically.

DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15

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Post Options Post Options   Thanks (0) Thanks(0)   Quote gpawelski Quote  Post ReplyReply Direct Link To This Post Posted: Jan 15 2010 at 8:48pm
Donna
 
I'm not one to let the politicalization of medical care overrule medical evidence.
Gregory D. Pawelski
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Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Jan 19 2010 at 9:11pm
DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15

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