Political Science and Mammograms

Last month, the U.S. Preventive Services Task Force (USPSTF) released their study and recommendations for breast cancer screening. There was an immediate universal rejection of the Task Force's work, from Senator Barbara Mikulski on the left to  Representative Michele Bachmann on the right. The outcry from Washington was deafening, and on December 2nd, researchers from the USPSTF actually apologized before a congressional committee for their study. 

Like most conservatives, I have a healthy skepticism of what I read in the mainstream media, especially concerning scientific research. So I  read the USPSTF's study. Their purpose was to update the 2002 USPSTF breast cancer screening recommendations, which included routine screening mammography every one to two years for women aged 40 to 49, and yearly at age 50 and above. The researchers evaluated "published reports of randomized, controlled screening trials and specifically updated information from mammography trials."  Among their conclusions:

-The USPSTF recommends against routine screening mammography in women aged 40 to 49 years.
-The USPSTF recommends biennial screening mammography for women aged 50 to 74 years.

The researchers based their recommendations on the calculation that the "number needed to invite for screening to extend one woman's life as 1,904 for women aged 40 to 49 years." In other words, for every woman aged 40 to 49 whose life is extended because of a screening mammogram, 1,904 women were found to be cancer-free. As for screening every two years instead of one, their research showed "little survival benefit is lost between screening every year versus every other year."

Scientists looked at the 1/1904 ratio and added up not only the financial expense, but also the possible harm that can come with a false positive mammogram (additional radiation exposure, possible biopsies, financial costs), and they concluded that yearly mammograms for all women starting at age 40 are not "beneficial."

Average Americans look at the 1/1904 ratio and conclude, "It's worth it if it's my aunt or wife or sister whose life is extended."

The media story concerning the USPSTF recommendations implied that the researchers were against providing mammograms for women until age 50. Actually, this is not quite true:

... the USPSTF reasoned that the additional benefit gained by starting screening at age 40 years rather than at age 50 years is small, and that moderate harms from screening remain at any age. This leads to the C recommendation. The USPSTF notes that a "C" grade is a recommendation against routine screening of women aged 40 to 49 years. The Task Force encourages individualized, informed decision making about when to start mammography screening.

The researchers concluded that the benefit of the previous recommendation of routine mammograms for all women before age 50 just isn't supported by the evidence. At no time in the study do the researchers recommend against any woman of any age being screened for breast cancer if she and her doctor decide that this is the best course for her.

The first problem is in the timing of the study's release. Those of us concerned with the inevitable rationing that will result from President Obama's comprehensive health care reform can't help but smell a rat, even if the publication of the study is entirely coincidental. It seems quite convenient that at the exact time that the Democrats are planning to add millions of people to a "public option" (and yet not raise the deficit), researchers have concluded that mammography is no longer necessary on a routine basis before age 50 and after age 70.

But the major difficulty these researchers face is what Sarah Palin calls "political science." Years ago, the treatment of breast cancer crossed from medical science to a political cause. Mammography morphed from a screening test to a women's rights issue. Politicians saw a cost-free way to establish their pro-woman bona fides by pressuring health insurance companies to cover yearly screening mammograms. How did they accomplish this? As usual, follow the money.

Insurance plans, like hospitals, are accredited. The National Committee for Quality Asssurance (
NCQA) monitors participating health insurance plans:

Accredited health plans today face a rigorous set of more than 60 standards and must report on their performance in more than 40 areas in order to earn NCQA's seal of approval ... If you're a provider or a health plan, we invite you to participate in our voluntary programs - doing so will help you achieve your potential and demonstrate to the world that you care about quality.

Participating in the NCQA's "voluntary programs" has other benefits besides "achieving potential." If a health plan wishes to participate in Medicare Advantage or the Federal Employees Health Benefits Program, NCQA accreditation is vital. Many states "recognize NCQA Accreditation as helping health plans meet state managed care requirements." And NCQA helpfully provides a "Medicaid Managed Care Toolkit" to assist in incorporating accreditation into state Medicaid agencies.

Currently, the NCQA
quality measure for mammograms "assesses the percentage of women 40-69 years of age who had a mammogram to screen for breast cancer during the measurement year or the year prior to the measurement year." In order to meet this measure, health plans need to demonstrate that female subscribers are being screened for breast cancer. So, not only do health plans have to pay for yearly routine mammograms, but they also need to encourage us to get them. Ever wonder why insurance companies send reminder letters to get your mammogram? They need subscribers to be screened to meet the NCQA measure in order to be accredited.

So now we have managed care companies paying for yearly mammograms for all, and it's not costing the government a penny. Conservatives have rightly claimed that universal health care reform will place Washington bureaucrats between patients and doctors. What we don't seem to grasp is that those bureaucrats are already in the examination room with us...except instead of telling doctors what they can't order, they're telling them what they must order.

The storm over mammography recommendations makes me wonder what will be the next "political science" issue to be challenged. I remember in the 1990s the firestorm over  "drive-by deliveries," or short hospital stays for new mothers. The public outcry became so great that Congress
passed a law in 1998 mandating insurance companies pay for a two-day post-partum hospital stay. If Congress actually passes a public option in their health care reform, don't be surprised to find this mandate quietly shelved. There might even be a study showing the benefits of an abbreviated stay after childbirth.. After all, Congress majored in Political Science.

Carol Peracchio is a registered nurse.
Last month, the U.S. Preventive Services Task Force (USPSTF) released their study and recommendations for breast cancer screening. There was an immediate universal rejection of the Task Force's work, from Senator Barbara Mikulski on the left to  Representative Michele Bachmann on the right. The outcry from Washington was deafening, and on December 2nd, researchers from the USPSTF actually apologized before a congressional committee for their study. 

Like most conservatives, I have a healthy skepticism of what I read in the mainstream media, especially concerning scientific research. So I  read the USPSTF's study. Their purpose was to update the 2002 USPSTF breast cancer screening recommendations, which included routine screening mammography every one to two years for women aged 40 to 49, and yearly at age 50 and above. The researchers evaluated "published reports of randomized, controlled screening trials and specifically updated information from mammography trials."  Among their conclusions:

-The USPSTF recommends against routine screening mammography in women aged 40 to 49 years.
-The USPSTF recommends biennial screening mammography for women aged 50 to 74 years.

The researchers based their recommendations on the calculation that the "number needed to invite for screening to extend one woman's life as 1,904 for women aged 40 to 49 years." In other words, for every woman aged 40 to 49 whose life is extended because of a screening mammogram, 1,904 women were found to be cancer-free. As for screening every two years instead of one, their research showed "little survival benefit is lost between screening every year versus every other year."

Scientists looked at the 1/1904 ratio and added up not only the financial expense, but also the possible harm that can come with a false positive mammogram (additional radiation exposure, possible biopsies, financial costs), and they concluded that yearly mammograms for all women starting at age 40 are not "beneficial."

Average Americans look at the 1/1904 ratio and conclude, "It's worth it if it's my aunt or wife or sister whose life is extended."

The media story concerning the USPSTF recommendations implied that the researchers were against providing mammograms for women until age 50. Actually, this is not quite true:

... the USPSTF reasoned that the additional benefit gained by starting screening at age 40 years rather than at age 50 years is small, and that moderate harms from screening remain at any age. This leads to the C recommendation. The USPSTF notes that a "C" grade is a recommendation against routine screening of women aged 40 to 49 years. The Task Force encourages individualized, informed decision making about when to start mammography screening.

The researchers concluded that the benefit of the previous recommendation of routine mammograms for all women before age 50 just isn't supported by the evidence. At no time in the study do the researchers recommend against any woman of any age being screened for breast cancer if she and her doctor decide that this is the best course for her.

The first problem is in the timing of the study's release. Those of us concerned with the inevitable rationing that will result from President Obama's comprehensive health care reform can't help but smell a rat, even if the publication of the study is entirely coincidental. It seems quite convenient that at the exact time that the Democrats are planning to add millions of people to a "public option" (and yet not raise the deficit), researchers have concluded that mammography is no longer necessary on a routine basis before age 50 and after age 70.

But the major difficulty these researchers face is what Sarah Palin calls "political science." Years ago, the treatment of breast cancer crossed from medical science to a political cause. Mammography morphed from a screening test to a women's rights issue. Politicians saw a cost-free way to establish their pro-woman bona fides by pressuring health insurance companies to cover yearly screening mammograms. How did they accomplish this? As usual, follow the money.

Insurance plans, like hospitals, are accredited. The National Committee for Quality Asssurance (
NCQA) monitors participating health insurance plans:

Accredited health plans today face a rigorous set of more than 60 standards and must report on their performance in more than 40 areas in order to earn NCQA's seal of approval ... If you're a provider or a health plan, we invite you to participate in our voluntary programs - doing so will help you achieve your potential and demonstrate to the world that you care about quality.

Participating in the NCQA's "voluntary programs" has other benefits besides "achieving potential." If a health plan wishes to participate in Medicare Advantage or the Federal Employees Health Benefits Program, NCQA accreditation is vital. Many states "recognize NCQA Accreditation as helping health plans meet state managed care requirements." And NCQA helpfully provides a "Medicaid Managed Care Toolkit" to assist in incorporating accreditation into state Medicaid agencies.

Currently, the NCQA
quality measure for mammograms "assesses the percentage of women 40-69 years of age who had a mammogram to screen for breast cancer during the measurement year or the year prior to the measurement year." In order to meet this measure, health plans need to demonstrate that female subscribers are being screened for breast cancer. So, not only do health plans have to pay for yearly routine mammograms, but they also need to encourage us to get them. Ever wonder why insurance companies send reminder letters to get your mammogram? They need subscribers to be screened to meet the NCQA measure in order to be accredited.

So now we have managed care companies paying for yearly mammograms for all, and it's not costing the government a penny. Conservatives have rightly claimed that universal health care reform will place Washington bureaucrats between patients and doctors. What we don't seem to grasp is that those bureaucrats are already in the examination room with us...except instead of telling doctors what they can't order, they're telling them what they must order.

The storm over mammography recommendations makes me wonder what will be the next "political science" issue to be challenged. I remember in the 1990s the firestorm over  "drive-by deliveries," or short hospital stays for new mothers. The public outcry became so great that Congress
passed a law in 1998 mandating insurance companies pay for a two-day post-partum hospital stay. If Congress actually passes a public option in their health care reform, don't be surprised to find this mandate quietly shelved. There might even be a study showing the benefits of an abbreviated stay after childbirth.. After all, Congress majored in Political Science.

Carol Peracchio is a registered nurse.