Friday, December 4, 2009

Increasing confusion about mammograms

Everyone is getting confused about mammogram guidelines. The U.S. Preventive Services Task Force (USPSTF) recently came out with new guidelines and these cancer screening recommendations are quite different from those published by the American Cancer Society (ACS). Now, the Senate is dealing with amendments of amendments. What do I mean by that? There was an amendment by Mikulski. Then, there was one by Vitter. Then the Murkowski amendment got rejected (I'm not sure if all this chronology is correct, but I think you get the picture). Soon, we won't remember what the original amendment said.

So what's with all these amendments? One key question is: how will insurance plans (including a possible public option) pay for screening mammograms? Who will need to pay a copay? What is the appropriate age to start breast cancer screening? 40? 50? How often should women get a mammogram?

I've heard some people argue that the USPSTF came up with these revised guidelines to reduce the number of mammograms the government would need to cover under the proposed public option. Does this make sense? Well, if the government can find a way to reduce health care costs, it would be to eliminate expensive tests. A mammogram isn't super expensive, but if you could stop all those women who are ages 40-49 from getting a mammogram, you would save a huge amount of money.

Are screening guidelines published to save costs or save lives? Where do you draw the line to declare that a screening test is indeed "cost effective?" How is that term even defined? At this point, I think that most of us have more questions than answers.

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