British Still Resist Screening Mammography--Why?

The Empire Strikes Back
The British always want to do less than the Americans (just ask Barak Obama), especially as regards breast cancer screening. Once again I picked up the the New York Times to read another article in which the Brits question the value of mammography. I guess since they lost the statistical and factual debate that mammography actually does save lives (which they resisted for years), they will now draw their limp straws and swing away with anecdote and opinion. The American press continues to support these ruminations as if they have validity which seems odd, doesn't it?

The Hundred Years War
In case you don't know, this argument used to go on constantly. The British have been kicking and screaming and resisting mammography for the better part of thirty years. As late as the 1990's their mammographic screening policy was: one view of each breast every three years! When the data finally settled the case that mammography saves lives they begrudgingly capitulated and now recommend two views of the breast every two-three years. But they still resist. You have to ask your self: Why?

The title of the most recent handmaid tale from Britain in the NYT: Benefits of Mammogram Under Debate in Britain. I'm won't bore you with all the details, but you can trust me on this summation of today's controversy: A woman (let's call her Anecdotal Lady Agatha) underwent a screening mammogram which was positive for cancer.

"She had a lumpectomy but was offered such a confusing array of treatment options that she realized doctors knew little about how aggressively to treat this kind of cancer."

This woman turned out to have a low-grade tumnor (DCIS -- which is not always low-grade)and basically, hers and the the British complaint is that we (Americans) find too many women with breast cancer and some of these women (they admit there is no way to tell which ones before a biopsy) do not need full-on breast cancer therapy, and it is difficult to know how aggressively to treat this particular subset of breast cancer. The British solution? Don't look so hard, and you won't find so many low-grade cancers (nor high-grade cancers I might add).

To ameliorate this "problem" a British mammogram expert,Dr. Peter C. Gotzsche,rewrote a "letter" provided to British women regarding mammography screening:

“It may be reasonable to attend breast cancer screening with mammography, but it may also be reasonable not to attend.”

The Objective of Mammography
The British doctors worry about too many biopsies which result in extra cost, stress to the women, and extra radiation during repeat mammographic imaging. Don't they sound like nannies?

What about cancer? They don't mention that.

The object of mammography is to find cancer. That's the prime directive: FIND CANCER. If a mammogram finds a cancer, it's done its job. If the surgeons and pathologists and oncologists have yet to sort out which cancers need treating, that's just the state of their art; however, to look less hard for cancer clearly in inimical to what we, in the U.S. want. We want to find all the cancer possible -- and if you don't believe me consult the Tort system which has the accuracy rates sighted on infinity. Or ask any breast cancer advocate.

Socialist Mind Set
In the British health care system, the individual is less well regarded than the group, which is the state. This is the system we are moving toward. It therefore makes sense that the British want to do less when doing more is costly. In the United States our health care system has always done everything it can all the time despite the cost. It's a mindset.

Are we ready to change mindsets? Are we ready to understand that you can't try to save everyone all the time? That it may not be worthwhile to save one person if the cost incurred is deemed to be asymmetrical to the system?

And if we are, then are we ready to abandon the Tort system that penalizes the failures to each individual--because some individuals are going to the graveyard (or worse)-- because the system cannot afford to respond individually.

One thing the reformers of our health care system are not accounting for is the American mind set. If people wake up and understand that "health care reform" means the government has to make funding choices that pit the individual against society, then maybe even all the false hue of crisis will not cover the fundamental changes being proposed out of Washington in the name of hope.

Defending Breast Cancer

ANCHORS AWAY


Recently, I was investigating a study done at Harvard measuring the cortisol levels of women waiting for the results of their breast biopsies. Cortisol is, roughly, considered a "stress" hormone. Biopsy results can take 2-7 days to process and get back to the patient.

Basically, the idea of this study was to prove that waiting for results causes anxiety and this is bad for women; and, by extension, we should rearrange the "system" so that women don't have to wait for their results.

Reading through this paper, I was captivated by the study's disclaimers (like which researcher is on the board of what conflicting company, etc) when I was thunderstruck by a simple statement: This study was funded by the Department of Defense.

The who?

GUNS AND BUTTER AND BREAST CANCER

Turns out that a disease-specific lobby group, the National Breast Cancer Coalition Program somehow "convinced" the Department of Defense that it had to use its budget to support breast cancer research, for which the DOD has spent $1.9 billion since the early 1990's.

What? Well at least they are spending that money on groundbreaking research, like the Harvard study!

Arm twisting by clever disease-specific lobbies -- especially those representing perceived minority groups -- can blackmail legislators into supporting programs like this in end-around spending programs funnelled through non-traditional (and nonsensical) federal funding avenues.

The institution affected (like the DOD) then ends up funding the program--usually forever-- no matter how silly the research. And they spend tons of money. Money wasted on peripheral research that could be used for MEDICINE AND SURGERY...or, GUNS and BUTTER.

For instance, this "funding program" was originally put in place in the 1993 DOD budget and the price tag was $210 million. But like all government giveaways, once they are put in place they are pretty hard to get rid of -- and this profligacy continues to this very day.

Disease-specific lobbyists and their effects need to be addressed in any "health-care" reform initiative, and their unseen costs to the system should be assessed.

According to Wikipedia:

Through the DOD , NBCC worked vigorously to ensure consumer activist
participation at the peer-review research table

Well, that's just what the system needs--consumer activists (are those like community organizers?) at the peer-review research table (otherwise known as the trough).

END OF AN ERA

As reported recently in The Atlantic, the US risks losing its supreme air power dominance during Obama's tenure as generals face the reality of being unable to replace our aging force of F-15's with the miraculous F-22's -- given the strictures of the Obama's DOD budget.

Hi-tech fighter aircraft, new warships and missile defense projects are all potential targets for big cuts in the US defense budget, as the American military faces a new era of limits under President Barack Obama.

So why are we spending $2 billion of the DOD's budget trying to figure out how anxious women are as they wait up to one week for breast biopsy results (95% of which are NEGATIVE)?

According to its website, the mission of the Department of Defense is:

...to provide the military forces needed to deter war and to protect the security of our country. The department's headquarters is at the Pentagon.

I guess there is a war on cancer...

Searching for Breast Cancer in California

An interventional radiologist doctor in California -- a Dr. Bittner -- has made Section B in the Wall Street Journal for doing liposuction and burning the removed fat in his automobile, or some such thing.

A much more interesting part of this article about the entrepreneurial Bittner is a side report of how the government came after him in 2003 for proferring MRI of the breast as a cancer screening tool:

... he operated a chain of radiology-imaging shops in California and other states. He offered magnetic resonance imaging, or MRI, that he claimed was better than mammography for detecting breast cancer. In 2003, the California board claimed this was false advertising in a civil suit it filed against him and the company he founded, HealthScan America Inc. The shops closed at about the same time. In 2004, a California state court ruled against the business

Shops? Why do they call them shops? A place where MRI of the breast is done is an imaging center, no? And why in Good Arnold's name would the State be chasing after doctors who are recommending THE TRUTH... namely, MRI is actually WAY better at finding breast cancer than mammography. And it was that way in 2003, believe me.

So why did the government go after him? I know why. But the truth is too shocking, aparently, for you lay people.

So shocking that when I wrote a book about this very subject, in 2006, I could not get it published. No one wants to hear it. No one wants to know. I was told that...well...maybe I shouldn't say.

I will, though.

Stay tuned; I'll get around to it, I promise.