Mammograms

The dollars saved are nearly negligible, but the political costs of scaling back breast cancer screening for tens of thousands of low-income women have turned out to be huge. Twenty-one members of California's congressional delegation -- Republicans and Democrats alike -- have sent a letter rebuking the governor for the move. State lawmakers are warning that people will die. Audits are being demanded. The Assembly Budget Committee chairwoman is even organizing a symbolic bake sale.

Still not sold on McCain Re "McCain comes back, swinging," Dec. 7 John McCain opposes President Obama's plan to set withdrawal deadlines in Afghanistan. He supported former President George W. Bush's open-ended military engagement for the last eight years, and what has it gotten us? It's time to stop turning our watches back with the honorable old war horse and try something new. His way hasn't worked. Marc Gerber Encino McCain's parting line on the Senate floor last Friday -- "It's been fun" -- is chilling.

Women in their 40s should begin getting mammograms whenever they want, members of a U.S. advisory group told a House hearing Wednesday, saying their "poorly worded" recommendations last month had confused people. Physicians with the U.S. Preventive Services Task Force told a House hearing that they had not meant to suggest that screenings were unnecessary for patients in that age group. Instead, the physicians said, they meant that screening is more effective for those 50 to 74. Republicans had trumpeted the initial recommendations, issued Nov. 16, as evidence that the Democratic-sponsored healthcare overhaul would lead to rationing of medical care.

Has feminism been replaced by the pink-ribbon breast cancer cult? When the House passed the Stupak amendment, which would take away abortion rights from women who get any government help purchasing insurance, the female response ranged from muted to inaudible. Soon after, when the U.S. Preventive Services Task Force recommended that regular screening mammography not start until age 50, all hell broke loose. Sheryl Crowe, Whoopi Goldberg and Olivia Newton-John raised their voices in protest; a few dozen non-boldface women picketed the Department of Health and Human Services.

In June of 1991, I found a lump in my left breast. I found it in the shower while performing a self-examination of my breasts, following the instructions on the little plastic card that hung from the shower rod. The lump was easy to find. It hurt. I called our family physician. "Thank God," he said. "If it hurts, it can't be breast cancer." I didn't know this was a myth and, obviously, neither did my doctor. Nor did I know that many, many women find their own breast cancers.

Some reader questions about the proposed healthcare legislation in Congress: How reliable are Congressional Budget Office cost estimates for the healthcare bills? I keep hearing that the bill is much more expensive than the CBO says. The CBO's job is to give lawmakers an idea of what a bill would cost over the first decade it was in force. In the House and Senate healthcare bills, some of the costs wouldn't take effect for several years, but some of the savings would take effect immediately.

It's such an appealing idea -- catch breast cancer early, treat accordingly and your patients will live. So perhaps it's no wonder the U.S. Preventive Services Task Force -- a panel of primary care physicians -- caught major flak when it revised its guidelines to say most women don't need mammograms until they turn 50, and thereafter every other year. Previously the recommendations had been to start getting mammograms at age 40, and then every one or two years. The new guidelines were met with a maelstrom of impassioned reaction from doctors.

Only days after a federal panel scaled back on breast cancer screening recommendations for many women, another organization -- the American College of Obstetricians and Gynecologists -- has done the same for a screening credited with drastically reducing the rates of cervical cancer in the U.S. Women of all ages should undergo Pap smears less frequently than they do now, those new guidelines say. And young women are advised not to bother until age...

Everyone who knows the prevailing medical wisdom on hormone replacement therapy for menopausal women, please stand up. Feels lonely up there, doesn't it? Hormone therapy after menopause was standard practice after a 1991 study found that it reduced the risk of cardiovascular disease -- until a study 11 years later found the opposite. Since then, the treatment has been linked to other health problems -- and found to have some advantages as well. Some doctors highly recommend hormones; others warn their patients away from them.

Health and Human Services Secretary Kathleen Sebelius said Wednesday that the controversial new guidelines for breast cancer screening do not represent government policy, as the Obama administration sought to keep the debate over mammograms from undermining the prospects for healthcare reform. In a written statement, Sebelius said the guidelines had "caused a great deal of confusion and worry among women and their families across this country" and stressed that they were issued by "an outside independent panel of doctors and scientists who . . . do not set federal policy and . . . don't determine what services are covered by the federal government."