How To Piss Off Dr. Sanjay Gupta: Lazy Mammogram Guidelines
Did anybody else catch today’s conversation between CNN’s Dr. Sanjay Gupta and Nurse Lucy Marion from the U.S. Preventive Task Force (the group that released this week’s controversial recommendation that women should begin routine mammograms 10 years later than previously determined, and perform less self-examinations–in order to prevent unnecessary “anxiety” and costly biopsy tests)?
We don’t have the terse/awkward video, but here’s a transcript of the throwdown:
SANJAY GUPTA, CNN CHIEF MEDICAL CORRESPONDENT: About 75 to 90 percent of breast cancers are found in women who have absolutely no family history and no identifiable risk factors. If you are a woman hearing that at age 40, right now watching, 75 to 90 percent of breast cancers found with people who have no risk factors, no family history, what should they do?
LUCY MARION, PREVENTIVE SERVICES TASK FORCE: I would not recommend it. I would not make a recommendation. We’re saying that the benefits are small.
GUPTA: What do you mean by that? When you say the benefits are small? Let’s not beat around the bush here. What exactly are you trying to say?
MARION: We look at it in various ways. For example, we look at life years gained by the actual screening every year or every other year. And the life years gained for that group is not very large. There are some life years gained. But it’s not very large.
GUPTA: You’re a nurse and…
MARION: And I know…
GUPTA: I don’t want to, you know…
MARION: I am.
GUPTA: … dig ourselves into a whole [sic] here. You’re a nurse, you’re in a profession of healing and compassion.
Are you comfortable with what you’re saying right now? Because what you’re saying, what I’m hearing you say is that you’re saying some lives just aren’t worth it. We — that’s why we’re changing these screening recommendations. And that is an incredibly frightening thing to hear from someone like yourself.
Is that what you’re saying?
MARION: No, I’m not saying that some lives are worth it. I do not say that. But as you know, as a physician, there are many screening tests that could save lives but could create many other issues that we made decisions about.
GUPTA: So, really, the harm that you’re saying to women, the harm that you cite is that it could cause unnecessary anxiety and worry in women who get these mammograms, for example, if they have a false positive? Do you think that it would cause anxiety in women if they are told that look, 90 percent — up to 90 percent of women who develop breast cancer never had a risk factor and now you’re not sure if you have that breast cancer because you didn’t get the test? Don’t you think that causes anxiety as well?
MARION: Yes, we know that the biggest risk factor is age. And that’s clear. And so the other — and we know other risk factors and we know that many do not have known risk factors if you don’t include age.
Dude, Gupta! Remind us never to debate you on camera. You’ve got a stronger tongue than a David E. Kelley character.
But thank you for pressing back hard against this recommendation–which could heavily influence caregivers, insurance companies, and those who are penning policy. We’re not jumping to conclusions, but it feels awfully fishy that a government agency seems to suddenly care about our mental health, and eerily coincidental that fewer mammograms and biopsies would ultimately cost medical insurance companies less dollars (we guess dead patients cost less, too). The way we see it, this recommendation boils down to less women detecting that they are sick, and that is simply unacceptable.
Frankly, we don’t care if our sisters, moms and friends only potentially gain “some” life years by screening frequently for breast cancer. We’ll take a day or a week or a month with our ladies over a bunch of computer data, so there you go. Dr. Gupta, please call us up before your next battle on this issue–we’ll be there with brass knuckles on.
[NYT: In Reversal, Panel Urges Mammograms at 50, Not 40]
[CNN: Transcripts 11.18.2009]
[AC360 Blog: Gupta On Mammogram Advice]
Thanks, Maris!
Filed under: Breast Cancer, Breast Cancer Awareness, Breast Exams, CNN, Controversy, Dr. Sanjay Gupta, Early Detection, Health Care Reform, Lucy Marion R.N., Mammograms, Medical Insurance Companies, Recommendations, U.S. Preventive Services Task Force
If you read the comments over on jezebel http://jezebel.com/5407384/new-breast-cancer-screening-guidelines-spark-confusion-criticism I think there you can see how the new guidelines can make sense. Like what the ‘years’ gained really mean.
The anxiety is terrible and if we consider what are the actual risks we should reconsider how we approach detection. My cousin is only 24 and during a breast exam found a lump, and even tho the doctor was pretty sure that it was most likely nothing(they mentioned that repeatedly) and could disappear on it’s own, but they still want to do more testing to be sure. She has no health insurance, and all the testing methods would costs a lot of money. Luckily her medicaid came thru and she had a follow up test that turned up nothing. I was anxiety ridden for her too. The culture of panic is harmful. We should approach this very touchy subject with a level head and not just let our emotions get the better of us.
Hat’s off to Dr. Gupta for pointing out the major hole in the argument. It’s as if the study was conducted by actuarials. It would be nice if we stopped wasting all this money researching a mediocre diagnostic tool and spend some real effort and money in developing a reliable test. Maybe coming up with a test that didn’t require pancaking the breast. We don’t test any other organ/part of the body in this manner. Why then do it to the boob?
You tell her, Dr. Gupta!
My mom is a breast cancer survivor. She nearly died from it, but here she is, 11 years later. You can never be too cautious when it comes to this stuff.
The government looks at the entire group, not the individuals, especially when it is footing the bill. So, if it is not cost effective to screen women 40-50 years old (and it isn’t), the government rightly sees this as an opportunity to save money.
The individual woman sees statistics from the other end, and, from her prospective it may indeed be cost effective to be screened for breast cancer with mammography between 40-50 years old. But then she needs to foot the bill.
Do you all not understand that this is what is going on here?
The more the government has the power to paricipate in these decisions, the more it will make the Socialist choice of the best decision for the largest number of people.
When people speak with their pocketbooks–they speak for themselves.
Waske up people.
Let’s look at what the “task force” has admitted to.
They state that for women age 40-49, it is necessary to screen about 1900 women — to save one woman’s from dying of breast cancer.
If you check the census data, you will see that there are about 22 million women in the US between the ages of 40 and 49.
If these women are not screen over the next ten years, one in 1900 will die an unnecessary death from breast cancer.
That works out to — about 25,000 women dead in the prime of their lives — when they could have been cured.
That’s more than the combined death toil from 9/11, the Iraq war I, the Iraq war II, and the Afghanistan war. . . .in fact, it’s about twice as much.
I wonder how much they’re paying the “task force” members for such wise counsel. . . .
While I have no doubt SG has women’s best interest, this is a complex issue.
As a 35 y o female whose mother was diagnosed w/ stage II (prolly IIa) breast CA, I am on the fence & have not gotten a baseline mammogram.
Mammograms are not completely innocuous.
Here’s a layman’s article http://www.nytimes.com/2009/12/01/health/research/01cancer.html
& here’s the oncologists’ stance
http://www.ajho.com/mammography-screenings-may-increase-breast-cancer-risk-in-young-high-risk-women/article/159223/
jpw