Thursday, November 19, 2009

New Breast Cancer Screening Recommendations

In case you are not familiar with the new breast cancer screenings the US government appointed task force has released, catch up with the story and comments before reading on.

Research is important, but “humane health care” must always be its girding foundation. Otherwise, recommendations like the ones the government just released will be adopted by insurance companies as a measure to save money – and ultimately neglect human lives.

The new recommendations have puzzled, if not outraged, many health care professionals. Frequent guest blogger and medical advisor, Dr. Satkirin Khalsa, and myself, felt we should likewise address this debate head on.

First, Dr. Khalsa’s comments: “(I) have so many young breast cancer patients in my own clinic, I am skeptical (of the recommendations).” Studies have shown repeatedly that early detection is the reason that we have seen a decrease in overall mortality from breast cancer. We also have better treatments, but we catch cases in earlier stages of disease when screenings occurs at a younger age. For example, in Wisconsin between 1981-2000, early stage breast cancer detection rose from 1.5% to 12.8%. The percentage increased the most in women aged 45-49.

Second, yes, it is true the recommendation is to “scale back” on screening, based on data from the past few decades. However, research is connecting the important link between Vitamin D deficiency with 17 (yes, that is right) types of cancer (including breast and prostate). “Adequate replacement of vitamin D3 in all of us SHOULD decrease our cancer risk, but it may take another decade before we see how this adequate replacement affects our risks.” This finding underscores why I have been blogging about vitamin D (the sunshine vitamin) for the past week, especially in light of the oncoming fall/winter season. It also underscores that with the vitamin D epidemic in this country, all women who are deficient will be at increased risk for breast cancer. Another reason that blanket recommendation should not be so readily adopted, possibly denying women their right to screening who may be at increased risk.

This women’s health issue affects the entire nation. Every woman diagnosed with breast cancer, whether under or over 50, is someone’s daughter, or mother, or loved one. Preventive care is, I believe, a basic human right, not a privilege. If only one woman's life is saved from early detection – would that not warrant the screening for all? What should scare everyone is that insurance companies may use these recommendations to deny screening and/or care to women under 50.

In the end, Dr. Khalsa adds, “I educate patients. They are free to make decisions about their own health.” Of course, they are only as “free” as the insurance companies will allow them to be. The medical “industry” is certainly an industry – it is big business. “Disease management vs. health care is the trend that I am seeing more and more.”

What is the take home message? Says Dr. Khalsa, “you must take responsibility and control of your own health, and not rely solely on doctors to tell you how you should or should not care for your self and your family. Many times, we (physicians) are wrong. Next week the evidence could change. But our intuition remains, and we cannot ignore it.”

As medical professionals we must rely on the evidence to guide our clinical decision making. However, intuition and patient/provider relationship is key. We must encourage women to still perform self breast exams, to be vigilant about the health of their mind, body, and soul, and to be active, not passive, in the health care process.

However, there is good news! Late afternoon on November 18th, the Health & Human Services Secretary, Kathleen Sebilius, had this to say about the recommendations. This morning, read about the Obama administration's new stance on the recommendations.

Can we breathe a sigh of relief? For the moment, it seems.

1 comment:

  1. Thank you Dr. Khalsa, Ginger Garner and Secretary Sebilius for taking a stand in favor of the data for at least the last half century. The United States' health care costs per capita are twice that of the 2nd highest nation and it is potentially irresponsible, and possibly criminal, to manage those costs on the backs of women who suffer more than 99% of all breast cancer diagnoses. This nation needs more women to have mammograms: the evidence shows that minority women have mammograms at a lower rate than do white women and minority women therefore suffer from a lack of early detection which then leads to a higher rate of death. The breast cancer rate of incidence for all women has been dropping for the last half century due to education, early detection and mammograms. Why undercut what is proven to work? Reinforcing this approach is the fact that the CDC reports that mammograms cut deaths from breast cancer by 1/3.

    Diane Nassir
    Sandia Park, NM