Mammograms–How we spend money

The recent recommendation of the United State Preventive Medicine Task Force elicited a violent response from women concerned about “devaluing” human life and the advantage of early diagnosis. Republicans are jumping on the issue complaining it’s rationing and government controls of health care.

Similar recommendations have long been in place for PSA screening in men. The problem in both instances is that the tests (mammograms and PSA) have a high rate of false positives–meaning many people without disease have to have other tests to prove there is no cancer–and a high rate of false negatives, meaning the test doesn’t diagnose all those with cancer. In addition, in younger women these problems are worse and the rate of cancer diagnosed only by mammogram is fleetingly small.

We’ve seen breast cancer in the 40-50 age group. But often the diagnosis is made though finding lump rather than the mammogram. We’ve also often seen people with normal mammograms who later find a lump.

We need some rules and guidelines and an understanding of what our love affair with technology costs.

Yes, I know, how can you put a price on human life but we’ve been doing it for years in the most unfair, least rational way possible, thorough financial rationing.

The republican conservative opposition is at least disingenuous and at worst totally hypocritical. They say we all have access to care through ERs which in case you didn’t know don’t offer mammograms. They’re also suggesting high deductible insurance as another solution. Care to guess what high-deductible means?

American’s delusion is that they can have everything in the way of health care without paying. Mammograms in my view should be considered from age 40 for women with any family history or if they have a strong desire to have the test. It should be a non discretionary part (remember in health care it’s ultimately the patient’s choice) of exams from age 50.

Neither mammograms nor PSA’s are expensive for an individual, compared to other medical procedures. If people really desire such a test and their coverage is inadequate it’s not too much of a burden to pay for it themselves. What should be covered is the follow-up should such testing be suspicious.

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