Mammogram, Self-Examination Cutbacks Threaten Women’s Health

I share the dismay of many patients and physicians over the recent recommendations to cut back mammography screening and breast self examination issued by the U.S. Preventative Services Task Force. This comes at a time when many in Congress in their zeal to formulate a new healthcare system are procuring two-thirds of the money by cutting the Medicare system. The pressure is on to ration healthcare spending for the majority of Americans in order to subsidize the new Health Reform Bills in Congress. Cutting screening mammography is only one example of how they may try to do it.

The government panel has recommended eliminating screening mammography for most women under 50. The so-called “science” used to justify these cuts in screening mammography defies common sense. It makes common sense that starting screening at 50 instead of 40 will result in tens of thousands of women with delayed diagnoses translating into more drastic therapy and/or death. It may well offend the many women who were saved by early breast cancer diagnoses in their 40s that now this government panel has decided that their lives are not worth the cost of the screening program. To those women 50 and older, they're saying that it’s not worth the money to make sure that their cancers are detected as early as possible. Instead, it’s fine for women over 50 to go an extra year between mammograms and therefore risk having a mastectomy instead of a lumpectomy. Perhaps the effort to discourage breast self-examination by women may also be an attempt to save money by preventing subsequent doctor's visits and tests. Incredibly, the panel minimizes several well respected studies that led to the “40 and over” yearly screening recommendation in the first place.

At this time, this is an example of a threat to diminish and ration health care to pay for a new system. Less well known is that the Health Reform Bills currently proposed by Congress actually do contain up to 30 percent Medicare cuts on other life-saving medical imaging technologies such as nuclear scans, CT scans and MRI scans. These medical imaging techniques have revolutionized detection and staging of many cancers, including breast cancer, as well as many other diseases. The new 30 percent Medicare cuts come in addition to 20 percent Medicare cuts for imaging that took place in 2007. Radiology facility closures from these large cuts will certainly affect availability of these life-saving tests for all patients.

In order to afford the cost of covering millions of new Americans in our contracting economy, these efforts show how Congress and the Administration will likely cut the level of care enjoyed by those who are currently insured. Most Americans are uncomfortable with these new spending choices, which will result in death or injury for many patients. Most physicians also support coverage for the uninsured, but not if it means that we lose access to lifesaving medical imaging tests and screening. It is therefore critical that all New Yorkers contact their Congressmembers to tell them not to cut funding for these critical radiology techniques.

Jay D Tartell M.D. is Associate Director of Radiology at the Mount Sinai Queens Hospital.