Breast Cancer Screening Standards and Conflicts of Interest

From Reuters: CHICAGO – Cancer experts fear new U.S. breast imaging guidelines that recommend against routine screening mammograms for women in their 40s may have their roots in the current drive in Washington to reform healthcare…

The decision of the U.S. Preventative Services Task Force, an influential group that crafts guidelines for doctors, insurance companies and policymakers, to backtrack on decades of medical advice urging women to begin getting regular mammograms at the age of 40 has stirred debate and anger.  The most alarming aspect of the report, however, is that the new standards being put forth may reflect U.S. health care cost management considerations rather than proper concern for the health of U.S. women. The report sites the “modest” benefits of earlier breast screening for cancer; read: cost-benefit analysis. Similarly, the report points to unnecessary medical treatment resulting from false positives; read: cheaper to miss a few genuine cancer diagnoses than to waste money treating false ones.

Mary Ellen Eagan
wrote, “First, let’s look at what the report means by “modest.” According to the data USPSTF collected, screening reduces the breast cancer death rate by 15%. In other words, one cancer death is prevented for every 1,904 women aged 40 to 49 who are screened for 10 years. This might not sound like much on paper, but what if you’re that one woman whose life is spared? What if that one woman is your wife, your mother or your daughter?”

Well, of course. Logically and practically speaking, however, one life can’t be allocated unlimited resources either. Discussing the new standards yesterday, a Fox News reporter opined, “I don’t think cost should be a factor when we’re talking about saving lives.” That is nonsense. Cost and allocation of scarce resources always have to be a factor. The issue is at the core of the health care debate. The legitimate question is, who or what is the best and fairest and most trustworthy entity to balance cost and lives? The woman and her family? The doctors and hospitals? Cancer prevention groups? The insurers? Or the government?

All of these have orientations and agendas that color and influence their analysis. The American Cancer Society, for example, opposes the new standards. Its agenda is to prevent as much breast cancer as possible. Insurance companies can be counted on to leap at the opportunities created by the task force’s recommendations, though they aren’t binding. Insurance companies want to pay for as little as possible, and now they have the ammunition to argue that those under-50 screenings are “unnecessary.” Families? They care more about costs if they don’t have money, and if they do have money, there is no reason to take any risks. If insurance companies start refusing to cover early screenings, then wealthier women, one in 1,904, will live, while one out of every group of 1,904 poorer won’t.

So what is the government’s angle? Our government “by the People, for the People” is supposed to care first and foremost about the health, safety and welfare of the citizens it represents. But once the government becomes responsible for health care costs, and makes keeping them under control a top priority, it has a conflict of interest. We will no longer be able to trust the government to be making its health recommendations based on what is best for our physical health, instead of what is best for the Treasury’s financial health.

Blog after blog, commentator after commentator, is expressing dark suspicions that the battle of U.S. women against breast cancer is being short-circuited in the interests of Obamacare budgeting and health care rationing. The Administration and spokespersons for the Task Force deny it, and perhaps they are telling the truth—or perhaps they are not. That’s the problem with conflicts of interest: when someone has split loyalties and conflicting objectives, it is impossible to know which interest is driving the decision.

It isn’t just health care. When the government is running General Motors, is it going to want to make safer cars at the expense of profitability? Is it going to want to make energy-efficient cars that are less safe? How will we know which competing interest and obligation takes priority?

Typically we won’t, just as we can’t be sure whether the new breast cancer screening standards arise out of a fair assessment of women’s health concerns, or are a conscious effort to sacrifice an “acceptable” number of young women’s lives to save on “unnecessary” expenses.

I am not taking sides here. But supporters and opponents of health care reform involving more government management must accept facts: the more the government is responsible for cost control, the more conflicted it is in setting health care standards. The more conflicted an entity is, the less it can or should be trusted.

Thus, a government panel’s conclusion that women don’t need regular mammograms until a full decade after they had been told that preventive screening was essential is raising suspicions of  hidden motives.

Get used to it.

5 thoughts on “Breast Cancer Screening Standards and Conflicts of Interest

  1. This is just the beginning of rationed health care. It is interesting to me that the commission making these new recommendations included NOT ONE ONCOLOGIST OR RADIOLOGIST, and asked no advice from either group before publishing those recommendations. This is what we’re in for if the Obama health care plan is passed. After 20 years of progress on breast cancer, with early detection now allowing women to know that breast cancer is not a death knell, we are now expected to knuckle under and move backwards, because a Washington commission says a “false positive” will “cause us undue anxiety” and “cost too much money to treat?” Let’s see now… What about the “anxiety” of finding a Stage Four breast cancer and knowing you are going to die? What about the cost of treating a Stage Four cancer as opposed to a simple lumpectomy five years before a mestastasis? WOMEN: FIGHT BACK!!! And, tell your Senator that this is just the beginning. Vote against the Obama plan… which, by the way, NO ONE HAS EVEN READ. Wonder what else is in those 1,500 pages?

  2. Call me a medical/political neophyte, but wouldn’t it have made more sense to take a “moderation” stance? As in, every two years from forty, and normal yearly from 50. Halving the number seems to be a good way to cut unnecessary costs while catching that small 15%.

    Be that as it may, the “self-exam” facet of the issue is completely valid. What if we allowed “self-exams” for other diseases? We’d have a flood of hypochondriacs and health nuts clogging up doctor’s offices and driving up costs. It’s just too easy to make a mistake in a self exam.

  3. Chase:
    1) Welcome to Ethics Alarms, and thanks for the comment.

    2) I don’t understand the point of trying to discourage self-exams. We all self-exam, every time we discover a lump or a blotch that looks suspicious. Skin cancer detection depends on self-exams. I think the objective should be to teach women to give themselves better self-exams, not fewer.

    3) I’m glad you mentioned this, because I should have discussed it in the piece. So the theory is, discourage women from checking they’re own bodies because they’ll go to the doctor too much?
    Huh? And the women the miss a discoverable lump in their thirties and die as a result are just collateral damage in a cost cutting measure? Really?

  4. This brings up one of the big problems with socialized medicine. When medicine is provided by a private individual or company, you can always turn to the government if you feel you are not being treated fairly. If the medical care is being provided by that same government, that mediation by the government is greatly diminished. It isn’t just conflict of interest, you have lost the checks and balances that protect the common person.

  5. I am writing a research paper on breast screening cancer and the conflict the insurances co. are having to pay for early screening. I could use from you the web sites for more info. and paper plublished articles for references. please if you can help I would appreicate it deeply for I am one of those family members who has the gene in my family history.

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