No Routine Mammograms for 40ish Women Sparks Rationing Debate

The word rationing, which connotes egg coupons and bread lines, is increasingly being applied to health care these days, with screening tests that do not show sufficient health benefits coming under fire by scientists who draw conclusions based on impartial clinical data. Mammograms are the latest screening test to be targeted by the U.S. Preventive Services Task Force (USPSTF), which issued new guidance to women in their 40s yesterday that routine mammograms may not be necessary and that women should discuss the benefits and risks of having a mammogram with their personal physicians.
The conclusion by USPSTF evoked immediate controversy among groups ranging from the American Cancer Society to young breast cancer survivors, who spoke critically of the task force's recommendation against routine biennial screening mammography for women in their 40s.
The USPSTF was formed by the U.S. Public Health Service in 1984 to objectively review and assess scientific evidence for various preventive medical services, including health screenings such as mammograms. According to its official website, the task force's recommendations are viewed as "the 'gold standard' for clinical preventive services."
While there has been a big uproar against the USPSTF panel's guidance against routine mammogram screening for women 40-49, the same task force has issued similar guidance for prostate screening for men over 75. The task force also found insufficient evidence for hospitals to routinely screen all babies for hyperbilirubinemia, a condition associated with jaundice, that can lead to a chronic condition called bilirubin encephalopathy.
Media doctors such as Dr. Sanjay Gupta of CNN and Dr. Dean Edell of KGO Radio both expressed non-alarmist views on the USPSTF guidance against routine mammograms for women in their 40s, suggesting that in the short term women would probably continue to get mammograms with their doctors' encouragement. However, both Gupta and Edell acknowledged that insurance companies could potentially stop covering these screenings for women under 50 who are not in a high-risk group (e.g., their mother had breast cancer), just as most insurance companies do not typically cover mammograms for women in their 30s who are not at high risk.
The concept of health care rationing is a controversial element of Pres. Barack Obama's health care reform initiative because health care savings cannot be achieved if screening tests are routinely administered that save only a few lives out of a million. While those few lives are very important, health care dollars are limited, and it is not necessarily humane to save a few lives at the expense of the millions of people who cannot afford any health insurance at all.
Reactions to the panel's controversial shift on routine mammogram recommendations for women under 50 are already flooding the blogosphere. A woman named Cathy, responding to a blog post on healthfreedomalliance.org, wrote: "Does the government think we are so stupid we can not see what they are doing? Next they will say we need physicals every ten years, no screening for high blood pressure or heart disease, etc. This is what happens when the government takes over our health care, and the sad thing is this will give private health insurances a legal basis to deny procedures. Americans will die for Obama's "successful" health plan!"
The panel's new guidance on routine mammograms for women in their 40s may hinder passage of a federal health care reform bill because without monetary savings accrued by eliminating tests and procedures with limited health benefits, health insurance for all Americans could ultimately have too high a price tag.
Sources:
http://www.ahrq.gov/clinic/pocketgd09/gcp09s2.htm#BreastScreening