My mammogram in September of 2013 found a tiny tumor near my left nipple. Oncologist said they’d remove it and I would not need chemo or radiation. In late October, the facility that does the screening in my area got a breast MRI machine. I had the scan and it found a very large tumor in the dense outer tissue closer to my underarm. When the two were removed, the much, by magnitudes, larger one was HER2 positive. If I had not had a breast MRI, I would have died from breast cancer years before it could be seen or felt.
I'm sorry but if I have a tumor I want to be treated like I'm in my 50s and not on Medicare. It should be MY choice if I want something removed I'm worth it all women are. I don't want Medicare making that choice for me just because they think I'm old.
Maybe profit motive and health/medicine aren't the best dancing partners. If you bring your car to a mechanic and say its making a noise, they'll find something they can bill you for. If you say you'll pay a reporter if he can find a story in something, he'll find the story. So forth and so on. Don't some of these scans make use of x-rays...which has its own relationship with cancer? The world is a racket.
This is helpful, thank you. I am one of those women whose physician recommends ultrasound or MRI due to dense breast tissue, but my insurance declines and I have very low risk by any assessment I’ve completed, so have never opted to pay for the additional testing. I also opt for every other year mammos, much to my physician’s chagrin.
I do have a question though. I’ve read on that screening mammograms do not improve survival, and that there is disagreement about when to start them. Is the issue that we should wait longer to start using mammography? Only use mammography based on risk factors and/or symptoms? Or is mammography just essentially useless and we like to irradiate breast tissue for no good reason?
The study referenced in this article is also interesting. The journalist says, "led to significantly improved survival rates", but the UofO media release doesn't quite say that.
..."Can journalism aspire to be curious?"...don't hold your breath. There is little proof that the health care system helps you be healthier or live longer in a healthier state. It's mostly a fantasy fueled by the fear of death.
Or these scans could help. We just don’t know without an RCT. I’m high risk, but my HMO won’t provide screening MRI or ultrasound. I make myself feel better by telling myself no one knows if these would help anyway.
On the other hand, I could die because of a missed cancer. No one knows - either way.
In 2011 OVERDIAGNOSEDby H Gilbert Welch( and coauthors) was published . It covered many of these issues.
Dr Prasad thinks it’s bad in the academic arena.Its much worse in the private sector. PCPs with a few PAs working for them, only care about moving patients through and getting good reviews on social media. I’m sure there are kickbacks from diagnostic labs and imaging centers. The rot is deep
We have a government that mandates t the coverage of “ trans care” for minors and adults( thank Obama for sneaking that into ACA) without any evidence .
There is no health care system in this country. What exists is very broken
Given that there is no test to tell which cancer will kill you, and which won't, screening is still important. It is what happens after a lump is found that needs to be worked on. Given existing law, an MD can't detect someone has a cancerous lump and tell them "let's see if it kills you". We need better determinants and tests on the back end. Screening i.e. finding the lump, is ok as long as the correct decision is made on the back end to either intervene...or not. Not screening isn't a solution as breast cancer kills women at very high rates and treatment of real, malignant tumors is effective.
Thank you for pointing out that NOT screening is no solution. All not screening does is save the insurances and Medicaid and Medicare money. As I seem to keep repeating, take the bean couners out of the loop and let doctors be doctors.
I guess you didn’t understand the argument that it’s possible screening is causing more harm than good. Unless we can show a net benefit, why should the public be paying for these screenings?
I do understand that the popular opinion is that screening can do more harm than good. But I've also seen lack of screening do more harm than good. All patients are different and physicians should be making the decision to screen or not to screen based upon the physician's knowledge of the patient. Insurances and Medicare and Medicaid should leave that decision to the physician, not categorically deny paying for screening tests.
I had to pay out the wazoo to get decent hrt. My Medicare-paid docs wanted to do no more than follow the footsteps painted on the floor by the Women's Health Initiative study that has screwed so many women since its publication. I thank God each and every day I can afford to pay a telemed clinic for actual "care". If I had to cut back on other things to afford it it's worth it. But demanding the government pay for it is unrealistic.
Thank you for your words of wisdom in this contentious debate on screening. I don’t begrudge anyone who chooses to opt out of the many tests/vaccines/screenings recommended by the medical powers that be. I stomped my feet and muttered every cuss word in my vocabulary all the way to the mammography center almost 3 years ago. I had dense fibrocystic breasts and was always told all the lumps were only cysts. The last mammo I will ever get showed something suspicious. It was invasive lobular carcinoma which had spread to the lymph nodes. No palpable lump.
Horrors! "Patients often end up paying the bill." Who ever dreamed that such a horrible thing could happen? Have we really reached the point where most people believe that because something is beneficial the government should pay for it? That is the clear implication when someone laments that Medicare is not paying for some medical cost.
We don't get Medicare for free we paid into the system and pay quarterly. Medicare costs more than the insurance I had when teaching. We deserve good quality of care just like people not on Medicare.
Medicare is not insurance and certainly is not run by the same principles as insurance. Much like Social Security, Medicare is simply government mandated (i.e. coercive) payments from one group of people to another group---in this case from taxpayers to people over 65 years of age. The amount of benefits paid bears no relationship to how much tax the recipient has paid in over the years. When supply and demand are forcibly separated from one another by government intervention we get soaring prices and all of the other problems that have plagued the medical care system since Medicare and Medicaid were started. When this sort of system reaches the breaking point we get rationing of medical care. This has already started and will likely get much worse in the very near future.
No. You didn’t pay for your Medicare. You paid for someone else’s because someone decided they have the authority to take your money and give it to someone else without your consent.
The adjective derives from the noun sophistry (the use of fallacious arguments, especially with the intention of deceiving), as interestingly does 'sophisticated'. Basically means BS.
Nice job with your logical fallacy. You have no argument against the merits of the idea that your healthcare isn’t your neighbor’s responsibility. It can certainly be assisted by generosity, but that doesn’t make it a an entitlement.
Actually sophistry and sophisticated have near opposite meanings. Sophistry became a pejorative term applied to some early Greek philosophers known as Sophists. Sophisticated refers to someone of great worldly experience or knowledge or describes a system or machine of great complexity---all considered very positive attributes. In any event, my use of the term was rather obvious sarcasm since you presented no argument at all.
Sophistication and complexity are both attributes of individuals, societies and systems that have become extremely fragile, often due to the arrogance of sophistry, resulting in decline and failure. Unrecognized tradeoffs are made and unintended consequences result from unexamined consideration of the attribution of positivity to all sophistication and complexity. Entropy is a bitch. Sophistry and sophistication share the same derivation with good reason.
Yes. It only looked at diagnosed cases. With today’s standards of diagnosis there are cases that would not have counted when that article was written decades ago.
All the cases that were diagnosed were lethal, but now we are diagnosing cancers that are not lethal ? Maybe they are not lethal because we remove them.
As a Medical Director for a midsize PPO/TPA in the Pacific Northwest (now retired), I fought this ‘coverage battle’ for 11 years. The battles continue…
I don't think Medicare is somehow being rational... they just have not gotten the political pressure on this. Cue the NYT and soon enough, they will bed paying for it and asking forgivess forf their sexist sins
In Illinois, it is now mandated that insurance pay for breast ultrasound and MRI. So, guess what? Everyone gets one. My Gynecologist told me they pretty much recommend them for everyone since they are paid for!!!! I mean, this just increases healthcare costs for all of us.
I have had cancer 4 times. That's fine if that is your gyn's opinion. I watched a young women 22 die of breast cancer because her doctor didn't think an MAmo was necessary. We are not getting these services for FREE we pay for them when we pay our insurance. Having testing done has saved me 4 times Colon cancer, fallopian tube cancer, skin cancer. Do I get yearly mammogram, you bet I do. To me it is necessary. It should be my choice. I pay for my insurance to keep me safe. if you don't want to do it yearly that is your choice just like having it done yearly is mine.
A 22 year old didn’t die because she didn’t get a mammogram. There is no way of knowing when that tumor began, but if she died at 22, it’s highly likely there was nothing anyone was going to be able to do for her. It is sad, but it is also life.
I would guess she is dead either due to a genetic mutation or because of some environmental factor.
My mammogram in September of 2013 found a tiny tumor near my left nipple. Oncologist said they’d remove it and I would not need chemo or radiation. In late October, the facility that does the screening in my area got a breast MRI machine. I had the scan and it found a very large tumor in the dense outer tissue closer to my underarm. When the two were removed, the much, by magnitudes, larger one was HER2 positive. If I had not had a breast MRI, I would have died from breast cancer years before it could be seen or felt.
I'm sorry but if I have a tumor I want to be treated like I'm in my 50s and not on Medicare. It should be MY choice if I want something removed I'm worth it all women are. I don't want Medicare making that choice for me just because they think I'm old.
It is your choice. It’s just not your choice to dictate how it’s paid for.
Maybe profit motive and health/medicine aren't the best dancing partners. If you bring your car to a mechanic and say its making a noise, they'll find something they can bill you for. If you say you'll pay a reporter if he can find a story in something, he'll find the story. So forth and so on. Don't some of these scans make use of x-rays...which has its own relationship with cancer? The world is a racket.
This is helpful, thank you. I am one of those women whose physician recommends ultrasound or MRI due to dense breast tissue, but my insurance declines and I have very low risk by any assessment I’ve completed, so have never opted to pay for the additional testing. I also opt for every other year mammos, much to my physician’s chagrin.
I do have a question though. I’ve read on that screening mammograms do not improve survival, and that there is disagreement about when to start them. Is the issue that we should wait longer to start using mammography? Only use mammography based on risk factors and/or symptoms? Or is mammography just essentially useless and we like to irradiate breast tissue for no good reason?
Indeed, I have so many issues with the way the health care system works. Above and beyond what happened in 2020-22.
This is odd. Is there some sort of coordinated push?
https://www.cbc.ca/news/politics/cancer-screening-canada-guidelines-1.7180878
The study referenced in this article is also interesting. The journalist says, "led to significantly improved survival rates", but the UofO media release doesn't quite say that.
Thx
..."Can journalism aspire to be curious?"...don't hold your breath. There is little proof that the health care system helps you be healthier or live longer in a healthier state. It's mostly a fantasy fueled by the fear of death.
Or these scans could help. We just don’t know without an RCT. I’m high risk, but my HMO won’t provide screening MRI or ultrasound. I make myself feel better by telling myself no one knows if these would help anyway.
On the other hand, I could die because of a missed cancer. No one knows - either way.
In 2011 OVERDIAGNOSEDby H Gilbert Welch( and coauthors) was published . It covered many of these issues.
Dr Prasad thinks it’s bad in the academic arena.Its much worse in the private sector. PCPs with a few PAs working for them, only care about moving patients through and getting good reviews on social media. I’m sure there are kickbacks from diagnostic labs and imaging centers. The rot is deep
We have a government that mandates t the coverage of “ trans care” for minors and adults( thank Obama for sneaking that into ACA) without any evidence .
There is no health care system in this country. What exists is very broken
Given that there is no test to tell which cancer will kill you, and which won't, screening is still important. It is what happens after a lump is found that needs to be worked on. Given existing law, an MD can't detect someone has a cancerous lump and tell them "let's see if it kills you". We need better determinants and tests on the back end. Screening i.e. finding the lump, is ok as long as the correct decision is made on the back end to either intervene...or not. Not screening isn't a solution as breast cancer kills women at very high rates and treatment of real, malignant tumors is effective.
Thank you for pointing out that NOT screening is no solution. All not screening does is save the insurances and Medicaid and Medicare money. As I seem to keep repeating, take the bean couners out of the loop and let doctors be doctors.
I guess you didn’t understand the argument that it’s possible screening is causing more harm than good. Unless we can show a net benefit, why should the public be paying for these screenings?
I do understand that the popular opinion is that screening can do more harm than good. But I've also seen lack of screening do more harm than good. All patients are different and physicians should be making the decision to screen or not to screen based upon the physician's knowledge of the patient. Insurances and Medicare and Medicaid should leave that decision to the physician, not categorically deny paying for screening tests.
They don’t make the decision on the screening. They make the decisions on who pays for it.
I had to pay out the wazoo to get decent hrt. My Medicare-paid docs wanted to do no more than follow the footsteps painted on the floor by the Women's Health Initiative study that has screwed so many women since its publication. I thank God each and every day I can afford to pay a telemed clinic for actual "care". If I had to cut back on other things to afford it it's worth it. But demanding the government pay for it is unrealistic.
Thank you for your words of wisdom in this contentious debate on screening. I don’t begrudge anyone who chooses to opt out of the many tests/vaccines/screenings recommended by the medical powers that be. I stomped my feet and muttered every cuss word in my vocabulary all the way to the mammography center almost 3 years ago. I had dense fibrocystic breasts and was always told all the lumps were only cysts. The last mammo I will ever get showed something suspicious. It was invasive lobular carcinoma which had spread to the lymph nodes. No palpable lump.
Horrors! "Patients often end up paying the bill." Who ever dreamed that such a horrible thing could happen? Have we really reached the point where most people believe that because something is beneficial the government should pay for it? That is the clear implication when someone laments that Medicare is not paying for some medical cost.
We don't get Medicare for free we paid into the system and pay quarterly. Medicare costs more than the insurance I had when teaching. We deserve good quality of care just like people not on Medicare.
Maybe it costs more because it's administered by a bunch of government loafers and the money that finds its way to doctors is much reduced.
Medicare is not insurance and certainly is not run by the same principles as insurance. Much like Social Security, Medicare is simply government mandated (i.e. coercive) payments from one group of people to another group---in this case from taxpayers to people over 65 years of age. The amount of benefits paid bears no relationship to how much tax the recipient has paid in over the years. When supply and demand are forcibly separated from one another by government intervention we get soaring prices and all of the other problems that have plagued the medical care system since Medicare and Medicaid were started. When this sort of system reaches the breaking point we get rationing of medical care. This has already started and will likely get much worse in the very near future.
No. You didn’t pay for your Medicare. You paid for someone else’s because someone decided they have the authority to take your money and give it to someone else without your consent.
Probably the best summary of the system I have seen in a single sentence and applies to every coercive government "service".
What an extraordinary pile of sophistic ultra libertarian crap!
So what are you saying? You're name calling but what's your argument?
Please pay my bills.
Hard to respond to a sophisticated argument like that.
The adjective derives from the noun sophistry (the use of fallacious arguments, especially with the intention of deceiving), as interestingly does 'sophisticated'. Basically means BS.
Nice job with your logical fallacy. You have no argument against the merits of the idea that your healthcare isn’t your neighbor’s responsibility. It can certainly be assisted by generosity, but that doesn’t make it a an entitlement.
Actually sophistry and sophisticated have near opposite meanings. Sophistry became a pejorative term applied to some early Greek philosophers known as Sophists. Sophisticated refers to someone of great worldly experience or knowledge or describes a system or machine of great complexity---all considered very positive attributes. In any event, my use of the term was rather obvious sarcasm since you presented no argument at all.
Sophistication and complexity are both attributes of individuals, societies and systems that have become extremely fragile, often due to the arrogance of sophistry, resulting in decline and failure. Unrecognized tradeoffs are made and unintended consequences result from unexamined consideration of the attribution of positivity to all sophistication and complexity. Entropy is a bitch. Sophistry and sophistication share the same derivation with good reason.
100% of breast cancers were fatal before the surgical era.
https://pubmed.ncbi.nlm.nih.gov/5220111/
Not true. 100% of fatal breast cancers were fatal before the surgical era.
Have you read the article?
Yes. It only looked at diagnosed cases. With today’s standards of diagnosis there are cases that would not have counted when that article was written decades ago.
All the cases that were diagnosed were lethal, but now we are diagnosing cancers that are not lethal ? Maybe they are not lethal because we remove them.
Many are not lethal.
How do you know? What percentage of breast cancers are not lethal if not removed?
As a Medical Director for a midsize PPO/TPA in the Pacific Northwest (now retired), I fought this ‘coverage battle’ for 11 years. The battles continue…
I don't think Medicare is somehow being rational... they just have not gotten the political pressure on this. Cue the NYT and soon enough, they will bed paying for it and asking forgivess forf their sexist sins
In Illinois, it is now mandated that insurance pay for breast ultrasound and MRI. So, guess what? Everyone gets one. My Gynecologist told me they pretty much recommend them for everyone since they are paid for!!!! I mean, this just increases healthcare costs for all of us.
I have had cancer 4 times. That's fine if that is your gyn's opinion. I watched a young women 22 die of breast cancer because her doctor didn't think an MAmo was necessary. We are not getting these services for FREE we pay for them when we pay our insurance. Having testing done has saved me 4 times Colon cancer, fallopian tube cancer, skin cancer. Do I get yearly mammogram, you bet I do. To me it is necessary. It should be my choice. I pay for my insurance to keep me safe. if you don't want to do it yearly that is your choice just like having it done yearly is mine.
Would you not get the scans if you had to pay for them?
A 22 year old didn’t die because she didn’t get a mammogram. There is no way of knowing when that tumor began, but if she died at 22, it’s highly likely there was nothing anyone was going to be able to do for her. It is sad, but it is also life.
I would guess she is dead either due to a genetic mutation or because of some environmental factor.