Mammogram Cutbacks: Make No Mistake, Rationing For
Women Has Begun
Elizabeth Lee Vliet, M.D.
am shocked and appalled at the cataclysmic shift in the guidelines
to later age and less frequent mammograms. This is diametrically
opposite from the American Cancer Society guidelines, and from what
most oncologists and practicing physicians think is needed.
Fundamentally, I do not agree with delaying mammograms to age 50, or
reducing screening to every two years, or stopping mammograms at age
74. I think these new guidelines are detrimental to our goals of
getting early detection and prompt treatment for women with breast
Even more ominous, the recommendation to start mammograms at age 50
instead of age 40 comes at a time when physicians are seeing younger
women developing breast cancer. It makes no sense to me as a
women’s health physician to suddenly decide to wait until an older
age to screen for breast cancer when we know that survival is
improved the earlier the diagnosis is made and treatment is begun.
makes no sense, that is, unless you realize that this change is
primarily designed to cut costs, not improve women’s health. I
think this is just the start of government-mandated guideline-based
rationing of healthcare. As has been the case my whole career, I
see that women are the first group to suffer when cost cutting takes
precedent over sound medical care.
Poor women, who depend on Medicaid or Medicare coverage, will be
hurt most of all since they are less likely to have the resources to
get mammograms if government insurance has decided to cut back and
pay for mammograms less often, or limit payment for the test based
This is exactly what has been going on with the
government-controlled health service in Britain! Due to cost
cutting, British women can only get NHS coverage for mammograms
every three years from age 50 to 70. What’s been the impact on
survival rates? British women have about 20% lower survival rates
with breast cancer than do American women.
Breast cancer is tragic and traumatic at any age. But breast cancer
does not have to cause death if it is caught early with a mammogram
so that treatment can be started before it spreads. In fact, if
caught earlier, there is a 90% cure rate for women with breast
cancer in the United States. American women have the best breast
cancer survival rates in the world because of our current guidelines
that help early detection.
Cutting back mammograms to every two years beginning at age 50 and
ending at age 74 is a change made by a government sponsored panel,
much like the ones being set up to decide your care under the Senate
and House healthcare “reform” bills now being discussed.
Who were not involved in making these new recommendations? The very
physicians you are most likely to see if you feel a lump: cancer
specialists, radiologists, and primary care physicians—who are your
first ally in getting prompt diagnosis.
The change in guidelines came from the distant and impersonal
“review of data” from published studies. This is very different
from physicians seeing patients and dealing one on one, face-to-face
with the emotional trauma that comes from a cancer diagnosis. As a
women’s health physician, I want the best and most timely diagnostic
tools available to help my patients determine what’s wrong. I am
profoundly concerned that government “experts,” far removed from the
daily care of patients, are sitting “on high” to proclaim that women
don’t need to start mammograms at age 40.
Even more disturbing: I think some of the reasons these experts
have given are paternalistic and demeaning to women. Example: It
causes "anxiety" to have a false positive mammogram. So? Women are
strong. Women can handle “anxiety.” What is worse? Brief anxiety
to find out a lump is not malignant (false positive)? To have the
greater trauma and anxiety from waiting until age 50 to have your
first mammogram, only to find you have a walnut-sized cancer that
has spread to your lymph nodes?
Breast cancers grow slowly. By the time a cancer has grown large
enough to be felt, it has generally been there for about 8 to 10
years. Cancers are caught on mammogram that are too small to be
felt, so treatment can be started sooner and women live longer. A
walnut-sized cancer clearly could have been diagnosed ten years
earlier if your first mammogram had been done at age 40, as under
For my patients, I am continuing to prescribe annual mammograms
beginning at age 40. I believe this is sound medical practice. I
believe this is in each woman’s best interest. And I am not going
to stop ordering mammograms just because a woman reaches age 74.
are just as worthy of early diagnosis and prompt treatment as are
younger women. If you are the woman who is missed because the
“guideline” did not fit, it’s your life at stake.
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Elizabeth Lee Vliet, M.D.
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