By Susan Rose
Special to Calbuzz
The official word from the federally funded U.S. Preventive Services Task Force — that most women don’t need mammograms until the age of 50 — generated passionate responses from women, medical associations and advocacy organizations.
The task force, a panel of physicians, also recommended against teaching women to do breast self- examinations. For good measure, a new recommendation to limit the frequency of Pap Smear Tests further added to the confusion about women’s health care protocols.
The timing could not have been worse for the White House, as the Administration struggles to pass health care reform.
Following closely the House passage of the disastrous anti-abortion Stupak Amendment, the new controversy has outraged many women’s organizations, leaving the uneasy Democratic coalition in Congress shakier than ever.
Why are all these attacks against standard women’s medical health practices coming now? Is it time to trust my paranoia? Is this directly connected to health insurance reform? The debate over saving money in health care suddenly seems to be tilting in favor of cutting services that serve women and save their lives.
Expressions of opposition to the new recommendations were widespread, as leaders like Nancy Brinker, founder of the Susan Komen Foundation, and influential women’s health author Dr. Judith Reichman pushed back at the task force report. Even the Obama administration backed away from the recommendations, leaving Health and Human Services Secretary Kathleen Sebelius to state that “our policies remain the same.” Perhaps most important, the American College of Obstetricians and Gynecologists confirmed their continuing support for the practices of screening mammograms for women from the ages of 40 to 49, as well as self-exams that can detect palpable breast cancer.
In their defense, the task force qualified their findings, saying they should be applied by “individualized decision making to the specific patient or situation” and advising the recommendations do not apply to high-risk women.
Good. That will work for my two 40-something daughters because they have a family history of breast cancer.
My story is no different than the many I have heard and the thousands repeated around the country. I was 47 years old when I was diagnosed with breast cancer. I had been examined by my gynecologist who missed the lump. A few weeks later I found it myself while doing a breast self-exam (BSE). The tumor was very small and I proceeded with the recommended treatments. This year I celebrated my 20th anniversary as a breast cancer survivor.
But two years after the first diagnosis, a Pap Smear revealed another cancer site unrelated to the first. It was found early, and required no additional treatment. The BSE and the Pap Smear are tests I continue to use to this day.
The task force’s recommendations have major implications for insurance coverage. As the Senate begins its debate on health care reform, ongoing analysis of the Stupak Amendment makes it clear that women may well lose all opportunities for abortions covered by insurance, because there will be little incentive for companies to provide these services. With formal recommendations from a federal task force now calling for limits on screening mammograms, why should insurers continue providing coverage for these services either?
Women have long been second class citizens in the history of medicine, ignored or treated differently than men. For many years, research on heart attacks was done on exclusively on men and the results then applied to women. Now scientists are looking at numbers of breast cancer diagnoses and deciding whether to provide women with preventive medical treatment. At what threshold are women worth being treated? We have moved from not being counted at all to being viewed only as statistics.
Scientific research and evaluation are important and the cost of health care needs to be managed, but there must be a way to do both without denying women basic medical services.
Advocates for the task force recommendations argue that they are about evidence- based medicine, and we should not mix science and politics. Perhaps, when gender equity is truly reflected in Congressional representation, we won’t have to fight these battles. Until then, we cannot separate out politics from science.
Susan Rose served 8 years on the Santa Barbara County Board of Supervisors and writes regularly about women’s issues for Calbuzz.