Mammogram Debate
http://thedianerehmshow.org/shows/2001-12-20/mammogram-debate
A recent analysis of mammogram studies suggests the screening procedure does not reduce mortality due to breast cancer. A panel talks about this finding and broader debate over breast cancer screening, treatment options, and research.
Guests
Dr. Barron Lerner
internist and historian at Columbia University's College of Physicians and Surgeons, and author of The Breast Cancer Wars (Oxford University Press)
Fran Visco
president of the National Breast Cancer Coalition
Stephen Feig
professor of radiology and director of breast imaging at Mt. Sinai School of Medicine
Comments
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Glad you are discussing mammograms (Ms). I was treated for DCIS with surgery and radiation in 2004 when I was 44, followed by 5 years on tamoxifen. Now self-employed, I have my health coverage through BCBS of Mass. To save on the premium, I elect a high ($2000) deductible plan. Having a deductible has taught me the difference between a screening M and a diagnostic M.
The screening M is free; the diagnostic M cost me $270 this year. (The hospital actually charges $606 but BCBSMA only reimburses the hospital $270.) It is more expensive because the technician must be more highly trained to do the extra, high-res pictures and the radiologist looks at those extra pictures. Paying this extra $300 out-of-pocket seems an unfair consequence of electing the high deductible plan. I am troubled by this built-in disincentive for women with a history of breast cancer to not have regular Ms.
I can't even have a regular screening M. They ask if you have a history of breast cancer, which automatically sets you up for the diagnostic M. Even if I were to lie, the scars on my breast make it self-evident. The extra pictures & cost seemed appropriate when I was on tamoxifen and being followed by an oncologist. Even now it seems right that I should have the extra pictures as part of a diagnostic M and entirely reasonable that this should cost more. It seems wrong that this extra cost should be passed along to me for the rest of my life.
I filed a grievance about this with BCBSMA a few years ago. What I recall is that Medicare policies determine how this is handled. My impression was: change the way Medicare deals with the two kinds of Ms and the insurance companies will follow suit. Wouldn’t it be more cost effective for health coverage to pay for regular Ms for women regardless of their breast health history, especially for women with a history of cancer? The sooner any recurrence is evident the more positive the treatment outcome.
I am interested in your guests' comments.