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[unspoiled]

I've even seen some more recent research that suggests that the problems caused by false positives on annual screening outweigh the numbers of extra lives saved.

I can't comment on this until I see a link.  

Link on the NHS breast screening programme website to the 2002 study that basically says that moving from a 3 year screening cycle to a yearly cycle isn't cost effective (this is a service paid for out of general taxation after all) and the change in the number of cancers detected isn't statistically significant.

Thanks for the article.  I have a professional deadline to meet so I expect I won't be able to read it properly and offer informed comments earlier than a week or two on the "statistically significant" part. This is just a quick note on the "cost-effective" part.  

Speaking strictly for myself, I know don't want to get sick, and I want to live as long and pain-free and as fully functional as possible.  I am concerned about the known and unknown side effects of procedures and treatments as much as anyone.  

If there are any side effects I am not aware of, let's hear them.  But when I prioritize my expenses, I will always pay for my health first, and in the absence of anything that has been proven to abide by loftier scientific standards, I will pay for the current standard of medical practice to be applied to my body.  

That said, I will definitely read your article.  

[unspoiled]

So, for all you women with pushy doctors. Just tell them to do it every three years and to do it right.

Thank you Wegie, that sounds like the NCI data I recall.

Doing it right = having it done at a facility dedicated to mammography, read by a radiologist who specializes in reading mammograms.

The NCI definitely instructs on where to get "high-quality mammograms."  I didn't find prompts anywhere however on the NCI website to have a mammogram every 3 years as opposed to every 1-2 years (unless one is under 40 and one counts the baseline mammogram that is apparently paid by Medicare between the ages of 35 and 39, and/or is at high risk).  

# Where can women get high-quality mammograms?

Women can get high-quality mammograms in breast clinics, hospital radiology departments, mobile vans, private radiology offices, and doctors’ offices.

The Mammography Quality Standards Act (MQSA) is a Federal law designed to ensure that mammograms are safe and reliable. Through the MQSA, all mammography facilities in the United States must meet stringent quality standards, be accredited by the Food and Drug Administration (FDA), and be inspected annually. The FDA ensures that mammography facilities across the country meet MQSA standards. These standards apply to the following people at the mammography facility:

    * The technologist who takes the mammogram.
    * The radiologist who interprets the mammogram.
    * The medical physicist who tests the mammography equipment.

Women can ask their doctors or staff at the mammography facility about FDA certification before making an appointment. All mammography facilities are required to display their FDA certificate. Women should look for the MQSA certificate at the mammography facility and check its expiration date. MQSA regulations also require mammography facilities to give patients an easy-to-read report on the results of their mammogram.

Information about local FDA-certified mammography facilities is available through the CIS at 1–800–4–CANCER (1–800–422–6237). Also, a list of these facilities is on the FDA’s Web site at http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMQSA/mqsa.cfm on the Internet.

[wegie]

If there are any side effects I am not aware of, let's hear them.  But when I prioritize my expenses, I will always pay for my health first, and in the absence of anything that has been proven to abide by loftier scientific standards, I will pay for the current standard of medical practice to be applied to my body. 

Ah, but remember what the NHS thinks is cost-effective and what an individual considers to be cost-effective can tend to be wildly opposed. The NHS, as a service paid for out of general taxation, is interested in getting the biggest clinical bang for their bucks (or pounds sterling) and has some fairly guidelines on how long life should be extended and at what quality of life before it will throw extra money at a problem. As a service that covers the whole of the population it looks at broad population data rather than at individual outcomes.

Now, if I was an individual who had to pay out of pocket for my health care (which, as I'm a child of the NHS I thankfully do not) my views of what is and isn't cost-effective would be likely to not cover broad population data ;-)

So, for all you women with pushy doctors. Just tell them to do it every three years and to do it right.

Thank you Wegie, that sounds like the NCI data I recall.

Doing it right = having it done at a facility dedicated to mammography, read by a radiologist who specializes in reading mammograms.

All UK breast cancer screening is done in dedicated centres. The NHS may get many things wrong, it may quite often creak at the seams, but it has learnt the lessons of allowing non-specialists to deal with mammograms.

You might also like this JAMA article. Basically, we seem to detect as much cancer as you do, but your recall rates are twice as high.

[inthelab]

You are right, Wegie, I do like the article.

[unspoiled]

Ah, but remember what the NHS thinks is cost-effective and what an individual considers to be cost-effective can tend to be wildly opposed. The NHS, as a service paid for out of general taxation, is interested in getting the biggest clinical bang for their bucks (or pounds sterling) and has some fairly guidelines on how long life should be extended and at what quality of life before it will throw extra money at a problem. As a service that covers the whole of the population it looks at broad population data rather than at individual outcomes.

Now, if I was an individual who had to pay out of pocket for my health care (which, as I'm a child of the NHS I thankfully do not) my views of what is and isn't cost-effective would be likely to not cover broad population data ;-)

Wegie, I'm afraid I've lost you there.  The NHS is in the UK.  I've only had to deal with them once and the specialist was marvelous, the GP not so.  I can't comment on NHS policies so I will import your point to the US and try to answer it there, again speaking strictly for myself.

I pay Medicare taxes and I am quite content with what breast cancer screening my tax money pays for towards myself and all the other US women who want to have this type of screening.  If they refuse this type of screening, it's not considered ethical for their physician (let alone taxpayers) to "obligate" them to undergo this or any other type of screening.  These women have a choice there.  I believe they don't have a choice whether to pay Medicare taxes or not, and if they do have a say as to how their Medicare taxes are spent (as they should have), this is probably not the most effective forum to debate that point though - if one's goal is to actually change Medicare coverage policies, that is.  If one is prepared to argue that breast cancer screening is wasteful (as in not cost-effective) then one should probably also be prepared to argue how cost-effective, comparatively, it is to treat stage 2, 3, metastatic and even terminal cancer lumped together (no pun intended). Personally, I am not that well trained in statistics to engage in that kind of meta-analysis.

[ideagirl]

I wonder if the tens of millions of Americans taking statins will realize all of the supposed benefits. They are pushing statins like crazy here-yes, even for people with normal numbers.  I wonder how people survived without Lipitor in years past. They were talking about treating children even when my kids were younger-maybe 10 years ago. As for Vitamin D, when they called and left that message for the test I didn't ask for,...

I hear you on the statins, and I'm huge on patients' rights and taking responsibility for your own health care, but as for the Vitamin D test, I have to smile. You are aware, right, that between 40% and 70% of Americans (exact number depends on demographic) are deficient in Vitamin D, thanks to sunscreen, lack of outdoor activity and inadequate nutrition? Doctors are not drug dealers or ATMs: their job is not to give you only the things you specifically request and nothing more. Does anyone here remember when doctors, as opposed to patients, were considered the authorities on what tests a person might need? As long as that's kept within reason (no overtesting, etc.), what is the problem with having someone who has actual medical training looking at your situation and thinking, "Hm, I might need a [cholesterol, vitamin D, etc.] test to get a better handle on what's going on here, and/or to give her health or nutrition advice suitable to her situation"?

I would have a completely different take on it if there were any indication the doctor were trying to push particular drugs or were getting kickbacks, but it seems weird to jump to that conclusion every time.