[Debbie L.]

I'm not even going to try talk about this, with the level of bias, anger, and fear that abounds here right now. But I WILL sign my name (laughing). I see that the few who have tried to inject some reason into these rants haven't signed their name - whether from simple oversight or fear of flaming we won't know. Anyway - here's one fairly simple, calm and unbiased editorial from the NYT, sent by me,
Debbie Laxague, who agrees with this editorial:

November 20, 2009
Editorial - The New York Times

The Controversy Over Mammograms

An expert panel's recommendation that mammography
screening to detect breast cancer be scaled back
has caused consternation among women and doctors
and prompted some attempts to connect the results
to the debate over health care.

It is important to keep the findings and
recommendations in perspective. They are guidance
for women and doctors. The decision about whether
to be screened is properly left to each woman –
to determine with the help of her doctor what
risks and benefits she is most comfortable accepting.

The new recommendation came from the United
States Preventive Services Task Force, a
government-appointed group of 16 outside experts
created 25 years ago to advise the Department of
Health and Human Services on the effectiveness of
various screening techniques. Half are women. The
panel‚s mission and expertise are medical, to
determine whether mammograms do more good than harm for women of various ages.

Its most controversial recommendations – in
conflict with recommendations from the American
Cancer Society and other medical groups – were
that women in their 40s should not routinely have
mammograms and that women between ages 50 and 74
should have mammograms every two years instead of
annually. That recommendation was based on an
analysis showing that every-other-year screenings
could provide 80 percent of the benefits of
annual screening while cutting the risks almost in half.

These recommendations have shocked many people,
but the American College of Physicians made
similar recommendations two years ago and the
National Breast Cancer Coalition, an advocacy
group for patients, has been saying for years
that mammography screening has been oversold, has
significant limitations and can cause harm. It
urges women to make their own decisions based on the best available facts.

In suggesting that women in their 40s not get
screened (unless they are at high risk for breast
cancer), the panel argued that the harms of
mammograms for those women appear to outweigh the benefits.

Screening turns up lots of tiny abnormalities
that are either not cancer or are slow-growing
cancers that would never progress to the point of
killing a woman and might not even become known
to her. If a suspicious abnormality is found,
women usually get another mammogram or imaging
test to better identify it and often a biopsy to
determine if it is cancerous. If it is, most
women have it treated with surgery, radiation,
hormone therapy or chemotherapy, all of which carry risks for the patient.

The scientific argument is that it is not worth
taking such risks for the large number of women
whose cancers grow too slowly to kill them. But
it is difficult, in practice, to apply that kind
of scientific analysis to the immediate questions
confronting a woman and her doctor when a
mammogram turns up an abnormality. The only real
solution will come when researchers find a way to
distinguish the dangerous, aggressive tumors that
need to be excised from the more languorous ones that do not.

The task force acknowledges that mammography
saves lives among women in their 40s. But it
estimates that more than 1,900 women have to be
screened for a decade to save a single life.
Among women in their 50s, when breast cancer is
more common, only about 1,300 women have to be
screened; among women in their 60s, only 377.

The panel concluded that the benefits outweighed
the risks among those over 50, but not in the
younger group. It found insufficient evidence to
determine whether digital mammography or magnetic
resonance imaging, two newer and more costly
technologies, are any better than standard film mammography.

The panel also cites the anxiety and distress
that many women experience when a mammogram finds something suspicious. Many women find that
argument condescending. Women in their 40s are
perfectly capable of managing anxiety and
deciding for themselves whether the uncertainty
that follows the detection of an abnormality in
their breast is worth enduring to know whether they have cancer or not.

Opponents of the health care reform bills moving
through Congress have seized on the new
recommendations as evidence that the government
is seeking to put bureaucrats between you and
your doctor or that it would ration care by
denying coverage for some mammograms that are now covered.

There is virtually no chance that any insurers,
either public or private, will deny coverage to
anyone based on these recommendations. Government
and industry officials have said that explicitly
and, in fact, every state but Utah requires
private insurers to pay for mammograms for women starting in their 40s.

There is nothing in the reform bills that would
change the current Medicare laws, which require
that annual mammograms be included among the
preventive services covered, an important benefit
for more than a million women in their 40s who
get Medicare coverage because they are disabled
or suffering from end-stage kidney disease.

The only part of the reform bills that could
affect mammography would only make them more
accessible. Under the legislation, the secretary
of health and human services might be given
authority to waive Medicare co-payments for
prevention services that rank highly in the
opinion of this task force. Since the task force
gave a low grade to screening women in their 40s,
the secretary could not waive cost-sharing for them.

There is nothing wrong with a healthy public
debate about mammography within the medical
community and among women who must decide when
and how often to get screened. It should not be
injected into the partisan debate over health care reform.