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Old 01-12-2010, 11:13 AM   #1
gdpawel
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Follow the mammogram money

Wall Street Journal's Alicia Mundy reported that the final health care bill in Congress is likely to require coverage for more mammagrams than the US recommended after women's groups, doctors and imaging equipment makers stepped up pressure on lawmakers.

From the article:

Adriane Fugh-Berman, a professor at Georgetown University's medical school in Washington, D.C., said the evidence supports less-frequent mammograms. "You have to ask if there's conflict of interest, because breast-cancer advocacy has become a big business," she said.

Ties between nonprofits and companies have been under attack by some consumer watchdogs. Sen. Chuck Grassley, an Iowa Republican, sent letters last month asking 33 major nonprofit groups including the American Cancer Society to disclose their industry funding.

The American Cancer Society said it has received less than $1 million from screening-device makers in the past five years. Its spokesman said the donations, which are small relative to the society's annual revenue of more than $1 billion, don't influence its recommendations.

The American College of Radiology, a trade group, called the new government guidelines scientifically unfounded, and said that if the guidelines are adopted, "two decades of decline in breast-cancer mortality could be reversed and countless American women may die needlessly."

Its flagship research program studies the role of radiology in medicine. It received donations of at least $1 million each from General Electric Co.'s GE Healthcare and Siemens AG, according to the trade group's 2007-08 annual report. Both companies make mammography equipment and MRI scanners. Several other medical-device makers donated at least $100,000.

A spokesman for GE said the new guidelines conflict with successful early-screening programs. A representative of Siemens didn't respond to a request for comment. The college of radiology said sponsors haven't influenced its research. It has spent $480,000 on lobbying in the past two years, while the imaging industry spent more than $2.5 million.

One of the largest breast-cancer-awareness groups, Susan G. Komen for the Cure, has worked with GE and other companies. Komen turned to GE in October when it lit the Great Pyramids pink to mark a major screening initiative in Egypt. Neither GE nor the Komen group would say how much the event cost.

In 2007, GE sold limited-edition pink cameras to Home Shopping Network, which donated a portion of the sales to Komen. Imaging and film companies whose products go into mammography equipment have made pink DVD players, pink computer flash drives and pink cellphones, a portion of whose sales raise money for Komen and other breast-cancer groups.

In events at the Capitol, Komen for the Cure founder Nancy Brinker has praised GE's digital mammography technology, and she received a public-service award from the company.

Ms. Brinker, sister of the late Susan G. Komen, said some patient-advocacy groups tended to represent industry views, but her organization's push has always been early detection.

A traveling mammogram van purchased this fall by the American Cancer Society, Komen and other advocacy groups for the Dana-Farber Cancer Institute in Boston touts a new GE Healthcare Senographe Essential digital-mammography system.

A lobbying group leading the charge in Washington against the new guidelines is the Access to Medical Imaging Coalition, whose members include GE and Siemens and several nonprofit patient groups, the college of radiology and leading doctors societies.

The coalition's director, Tim Trysla, is a lobbyist at a Washington law firm. He has been working in Congress against proposals to cut billions of dollars in Medicare spending in the health-overhaul bill that could hurt imaging-device makers.

http://online.wsj.com/article/SB126325763413725559.html
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Old 01-13-2010, 11:32 AM   #2
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Mammography Screening for Women Under Fifty

The storm that greeted the USPSTF guidelines on mammography screening for women in their 40s prompted the Senate to insert a mandate in its health care reform bill that every insurer cover every mammography screening test at no cost to beneficiaries.

The Journal of the American Medical Association (JAMA) published an article, "The Benefits and Harms of Mammography Screening: Understanding the Trade-offs," reminding physicians and women about the serious health costs of adopting that policy.

The authors, Dartmouth's Steven Woloshin and Lisa Schwartz, used the "number needed to treat" analysis to point out:

Without screening, 3.5 of 1000 women in their 40s will die of breast cancer over the next 10 years (ie, 996.5 of 1000 will not die of the disease).

Screening reduces the chance of breast cancer death from 3.5 to about 3 of 1000. In other words, 2000 women between 40 and 49 must be screened annually for the following ten years to save one life.

For most women with cancer, screening generally does not change the ultimate outcome; the cancer usually is just as treatable or just as deadly regardless of screening.

Finding cancers that were never destined to cause symptoms or result in death is the biggest problem with mammography, especially among younger women. Since it is impossible to know which cancers caught early are benign, all are treated with surgery, chemotherapy, radiation, or some combination. Overdiagnosed women undergo treatment that can only cause harm, and must live with the ongoing fear of cancer recurrence.

While only 7% of women believe there could be breast cancers that grow so slowly that leaving them alone would not affect their health, randomized clinical trials have consistently shown that the groups undergoing mammography have more breast cancer, even after 15 years of follow-up. This persistent difference represents overdiagnosis.

Estimates of the rate of overdiagnosis range from 2 women overdiagnosed for every breast cancer death avoided in one trial, to 10 to 1 in another.

Woloshin and Schwartz concluded: "The politicalization of medical care is wrong. Promoting screening irrespective of the evidence may garner votes but will not create healthier voters. People need balanced information. Simplistic slogans touting only the benefit are deceptive. Simple, standardized summaries about the benefits and harms of testing would help foster good decision making."
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Old 01-18-2010, 06:16 PM
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Old 09-09-2010, 07:08 AM   #4
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Lessons from the Mammography Wars

A thoughtful piece was published in the New England Journal of Medicine about the miscommunication that took place last November of what the USPSTF tried to convey and the complicity of certain organizations in adding to that confusion.

http://healthpolicyandreform.nejm.org/?p=12525
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