New Mammography Guidelines Jolt Medical Field
Doctors Predict By-product of Screening Debate: More Talk With Patients About Mammograms
No Changes in Insurance Coverage
With health care reform percolating in the background, the mammography
discussion immediately shifted to how the new advice would affect insurance
The leading health insurance trade group says insurers would maintain the
status quo on mammograms. “Our interpretation is that women should be talking
to their doctors, and if their doctor orders the test, then it would be
covered,’’ says Susan Pisano, a spokeswoman for America’s Health Insurance
Plans. “We’ve advocated for women to get screened. That hasn’t changed.
Doctors and patients should be talking about benefits and harms.’’
Secretary of Health and Human Services Department Kathleen Sebelius
admits the recommendations "caused a great deal of confusion and worry among
women and their families," and emphasizes that the department's policies remain
Women who are currently getting mammograms under Medicare will continue to be able to get them, says a
spokesman for the Centers for Medicare and Medicaid Services. Medicare is the
federal health insurance program for people 65 and older and the disabled.
How the new guidelines will affect private employer coverage is unclear,
according to benefits consulting firm Mercer. “It is too soon to tell," says
Mercer spokeswoman Stephanie Poe, adding that there is "too much conflicting
advice" for employers to know if or how they would change their benefits
Guidelines Often Change
The task force advice, meanwhile, offers an example of how the practice of
medicine is not set in stone, doctors say.
Much of medicine "is a work in progress," says Peter McGough, MD, a family
physician who practices in a Seattle outpatient clinic connected with
University of Washington Medicine. Doctors, he says, "are always thrilled when
the guidelines are well established and clear."
McGough likens the mammogram debate to disagreements over guidelines for prostate cancer screenings.
“We’ve always had to discuss it with patients - the benefits and risks - having
them working with us to make the call."
He says he already has changed his practice on breast self-examination
because recent scientific evidence shows it does not increase early
“A couple of years ago, I stopped reinforcing it," he says.
Still, he notes it’s a highly emotional topic. “My opinion is that breast
cancer, for women, is close to being No. 1 among their health concerns,"
Talk to Your Doctor
Stubbs says the task force guidelines are not much different from those
created by the American College of Physicians two years ago. Doctors now will
"be entering into more discussions with their patients," he says, and will
focus more on treating them as individuals.
Tom Bader, MD, chief of general obstetrics and gynecology at the University
of Pennsylvania, says the task force advice may change some doctors' practices,
but not his.
Meanwhile, Judi Chervenak, MD, an ob-gyn and associate clinical professor at
Montefiore Medical Center in New York, defends current ACOG recommendations for
routine mammography for women in their 40s.
“Catching something early may mean a woman may not need as aggressive a
therapy," she says. “If we have a modality that can pick up the disease early,
why can’t women have it?"
The risk of false-positives that the task force points out, Chervenak says,
"is insulting to a woman’s intelligence."
“It’s assuming that women can’t take the news that they have a
false-positive,’’ she says. “Women know there can be a false-positive."