Mammogram Preventive Service Task Force: Can’t See The Trees For The Forest

I intended to stay focused on issues related to tort reform until we got past the latest effort to pass federal tort reform legislation. But the pronouncements this week by the Task Force on screening for breast cancer changed my mind.

I have not had breast cancer although men do suffer from this disease. But I know breast cancer as a husband, a brother, a friend, and an attorney for breast cancer clients in my medical malpractice law practice. So I have known women who have died from breast cancer and I know both women who are living with metastatic spread of breast cancer with the likelihood of dying from it and women who are breast cancer survivors without evidence of recurrence. From my vantage point the Task Force recommendations are simply outrageous.

The Task Force report has a number of serious flaws. The most glaring is in its central recommendation which is to cut back on mammogram screening for women over 50 from once a year to every other year. The Task Force tries to portray its recommended 50% reduction in mammogram screening as being innocuous by pointing out that the screening every two years would still produce 81% of the benefits in mortality reduction that annual screening produces. At first blush, the Task Force Recommendation almost sounds reasonable. However, as always the devil is in the details.

The flip side of 81% is 19%. What does a loss of 19% of the benefit of annual mammogram screening mean in human terms? The Task Force acknowledges that annual mammogram screening results in a 15% reduction in breast cancer mortality. Based on the most recent information available, approximately 40,480 women are dying each year in our country from breast cancer. That means that annual screening saves the lives of approximately 6,000 women each year. Losing 19% of the benefit of annual screening by reducing screening to every two years would mean approximately 1,150 women will die from breast cancer annually who would otherwise have survived.

That’s a lot of women.

What was going on with the Task Force that losing the lives of 1,150 women does not give them pause? Part of the answer lies in the composition of the Task Force’s 15 member Panel. There was not a single board certified oncologist and only one board certified gynecologist on the Task Force Panel which, of course, was considering important oncology and gynecology issues. There were even more pediatricians on this breast cancer screening Task Force (2) than the combined total number of oncologists and gynecologists (1). Go figure.

This Task Force was overwhelmingly dominated by Public Health and Epidemiologist experts who are great at crunching numbers, doing statistical regression analyses, and preparing fancy charts. But in the process of looking at the “big picture”, they lost sight of the trees because of the forest. The Task Force needed clinicians to provide a broader perspective, physicians who are in the trenches treating women with cancer on a daily basis and who care about the tress, not just the forest. Unfortunately, whoever appointed this Panel failed to appoint clinicians from the appropriate fields of medicine to provide the balance the Task Force needed.

Is it important to reduce the overall amount of money being spent for screening mammograms in our country by 50% in order to achieve a better cost- benefit for saving lives from breast cancer? Maybe, but if so, why didn’t the Task Force focus on reducing the prices being charged for mammogram screening instead of reducing screenings by 50%? Do mammograms have to be so expensive? Are mammograms one of the cash cows of the hospitals’ radiology departments? Are the profit margins for mammograms so out of line that what is being charged for them represents price gouging? And why do mammograms in the United States cost so much more than they do, say, in Japan?

And, finally, the Task Force’s suggestion that saving women from the anxiety of waiting for the results of a breast biopsy is on the same plane as saving women’s lives is an insult. Aren’t we way past the paternalistic attitude that we need to protect ‘the little woman” from anxiety” least she wither and faint?

Women handle the stress that comes from demanding careers in industries and professions that still discriminate against them and from being advocates for their children in school and health care systems that fight them every step of the way. Worrying for a few weeks over whether you may have breast cancer while you wait for your biopsy results is not what any woman wants to do. But most women I believe would rather worry for a few weeks over a biopsy than stick their heads in the sand and pretend that life is free of worry when it is not.