Is anyone else really concerned that the latest "health screening reversals" have targeted women? See mammograms, and pelvic exams. I have yet to see the "let's stop screening men for prostate cancer" and "forget the colonoscopies" announcement.
Friday, November 20, 2009
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6 comments so far. What are your thoughts?
Yeah, I'm fairly appalled. My well-woman exam is only going to be covered once every *three years*. Once a year was bad enough!
And the breast exams...
Sigh.
Yeah. This is kinda weird to me. On the one hand, I recognized we have health care excess, and some of that is from excessive screenings. But for sexually active women, HPV and other STDs are often caught when they go in for a yearly pap. To tell them not to come in AT ALL until they're 21 kinda freaks me out.
And then breast exams... y'know, sorry, but I know way too many women who got breast cancer in their 40s. There's obviously a pretty measurable benefit to going in for an exam when you're 45 instead of 50: like, you know, living.
Trying to reconcile my deep distrust of any medical presciption that tells women to spend less time on their health concerns and alleviating some of the U.S.'s excessive health care costs. I feel like it's another instance where the first people who get told they're "the problem" are, as usual, women.
I'm too much of a historian (and I know too much about the history of women's health care - or lack of it - to swallow this whole).
Jenn, seriously? How many women are there where you work?
I'm all in favor of early-detection screening, particularly for cervical cancer and other cancers with high risk of glandular involvement; it saved my wife's life. And I've seen first-hand women's health issues being shunted aside by insurance companies, so I understand your outrage.
However, as a science-geek, I've got to say, your assertion in this case about not seeing the same for men with regard to prostate cancer is wrong. There was just a major recent study suggesting we not screen AT ALL for prostate cancer in men who do not have specific risk factors -- particularly family history. Their logic scared the crap out of older men, but was scientifically sound; namely, that prostate cancer diagnoses result in many surgeries, but statistically speaking, the danger of the polyps they remove is very low (so much so that detection and surgery or lack thereof has no net effect on morbidity and mortality in the test group). The study concluded it wasn't worth the expense and surgical risk, because these cancers grow so slowly, and come on late enough in life, that the men diagnosed are likely to die of something else before the prostate cancer ever gets 'em.
So the fault lies not in the statistical analyses of the scientists, but with the way those results are exploited by the media. And of course, it seems to me that people should have these studies explained to them, and have the right to opt into or out of more frequent testing as they see fit (for that one, blame the insurance companies, who saw their chance to protect their bottom line and did so.) But make no mistake, this one's not a gender issue -- it's one of money, pure and simple.
Do you have a link to that study?
My concern here is not that it's just a study (there are lots of "just a study" conflicting studies that should be taken with a grain of salt), but an actual federal advisory board recommending women don't get screened for breast cancer in their 40s: http://fleck.com/MFuHt
The pap-every-three-years recommendation didn't come from a federal advisory board, but it did come from a pretty big player whose study was then endorsed by the American Cancer Society.
So it's not just, "Hey, random study found X." It's "study found X, and the big guns are asking women to go with less healthcare."
If it is, indeed, true that we need less screenings for these highly lethal and women-specific diseases, then great.
But there's a historical component to this that makes me suspicious. Women do traditionally get shafted more than men when it comes to healthcare. Obstetrics in particular has been a really disgusting battle ground the last 100+ years. Folks like to point out the $$ going to breast cancer (which has only happened in the last 20 years due to incredible grassroots work primarily by women), but women are still undertreated for heart disease (there's still a myth that women suffer from it less than men), and insurance companies still charge women more or don't cover them at all if they've had previous cesarean sections (the famous "we recommend that in order to get coverage, you should get sterilized" letter from an insurance provider is a classic).
So yes, the rational part of me wants to say, "Hey, it's science!" But the historian part of me is highly suspicious of the timing and intention of studies telling women to take fewer steps in preventing major women-specific diseases.
I heard about the study in an NPR piece, but I'll see if I can dig it up. And you're absolutely right that it's what happens AFTER the study that is at issue, and I wouldn't at all be surprised if there's a systemic gender bias as to how these results are incorporated into healthcare coverage. In fact, if the gender bias bears out in spite of the fact that there actually is a comparable male study, it'd be even worse than if there'd been no male study at all.
And it's important to realize that these studies deal with statistical probabilities -- but that the personal, individual risk for these cancers is still high enough that people should be within their rights to demand more frequent screening. The pap recommendations I found particularly shocking.
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