Today, the United States Preventive Services Task Force released its recommendation that women begin routine breast cancer screening at age 50, instead of 40. It has based this on the modest benefit of mammograms versus the harm of overtreatment.
First, let me explain that the study’s idea of modest benefit is a fifteen percent reduction in breast cancer deaths. That number sounds kind of good to me. If I were one of those women, I’d be one hundred percent happy with that.*
And the harm of overtreatment? Cancers might be removed that would have grown too slowly to kill the women in which they are detected. As you can imagine, this is a real drag for insurance companies who have to pay for the procedures when they would be happier to spin the Wheel of Fortune and bet their customers will die of natural causes. And since insurance companies are for-profit organizations, that’s exactly what they do when insuring us.
The other egregious harm the task force cites? Can mammography kill us, as cancer can? No, but unnecessary tests can cause anxiety. Isn’t it so much better for us just not to worry our pretty little heads about it? After all, only fifteen percent of our mothers, sisters, and daughters will be saved. What a tough choice.
According to one statistician, although this will save billions of dollars in health costs, “the money was buying something of net negative value. This decision is a no-brainer. The economy benefits, but women are the major beneficiaries.” I’m no number cruncher, but when did a fifteen percent reduction in mortality have a negative value?
So, what I’d like to do is play a little word game with a New York Times article published on this subject. Wherever there’s a mention of women and breast cancer, I’m going to substitute something else. See if you can tell where:
Overall, the report says, the modest benefit of the exam — reducing the dick cancer death rate by 15 percent — must be weighed against the harms. And those harms loom larger for men in their 40s, who are 60 percent more likely to experience them than men 50 and older but are less likely to have their balls fall off, skewing the risk-benefit equation. The task force concluded that one death by cock rot is prevented for every 1,904 men age 40 to 49 who are screened for 10 years, compared with one prick withering for every 1,339 men age 50 to 74, and one fatal phallus for every 377 men age 60 to 69.
But the new report conflicts with advice from groups like the American Cancer Society and the American College of Radiology. They are staying with their guidelines advising annual knob screening starting at age 40.
The cancer society agreed that man-o-grams had risks as well as benefits but, he said, the society’s experts had looked at “‘virtually all” the task force and additional data and concluded that the benefits of annual exams starting at age 40 outweighed the risks of unnecessary dickectomy.
Private insurers are required by law in every state except Utah to pay for a chubby checker for men in their 40s.
But the new guidelines are expected to alter the grading system for health plans, which are used as a marketing tool. The message for most men is to forgo ensuring their johnsons aren’t killing them if they are in their 40s. In fact, even though exams are of greater benefit to older men, they still prevent only a small fraction of dick cancer deaths.
Researchers worry the new report will be interpreted as a political effort by the Obama administration to save money on health care costs.
Of course, Dr. Dingle Berry noted, if the new guidelines are followed, billions of dollars will be saved.
“But the money was buying something of net negative value,” he said. “This decision is a no-brainer. The economy benefits, but men are the major beneficiaries.”
Do you doubt that if the above were true, there would be a million men brandishing pitchforks and torches marching on Washington right now? You know the answer as well as I do. I’m just being a tease.
P.S. On a serious note, check out this study on digital mammography funded by the National Cancer Institute and published in 2005. Digital mammography is much more accurate in detecting breast cancer in women under 50 and in older women with dense breast tissue than traditional mammography. It saved my mother’s life. I may need it to save mine someday. But even at high risk, my insurance will not cover the computer-assisted exam. The superior technology exists, right now, to save more women. Why isn’t it recommended? Because it’s a lot more expensive than telling us not to worry or to wait to have the inferior test. Statistically speaking, we’re not worth it.
*Update 2018: As it turns out, I was one of those women. In June of 2012, at the age of 47, I was diagnosed with breast cancer. It was caught early because of a digital mammogram that showed enough detail for a radiologist to see a very small tumor. I’m lucky that my insurance covered the more sensitive test. If I’d had to wait until age 50 to get it, I could be dead now, and my little word game would just be a sad coda to my smart-alecky life. I’m happy it didn’t turn out that way.