should the government regulate mammograms

Medicine Globally by Dr. Rene Menguy

IS IT APPROPRIATE FOR THE GOVERNMENT
TO REGULATE TREATMENT DECISIONS?

By

Dr. Rene Menguy

It would appear that with every new dawn comes some new controversy created by the Administration. In a previous posting, I had a quote stating that were it not for the Government, we would have nothing to laugh about. Should I have written, to cry or scream about?

The current leitmotiv of the Conservatives and many Independents, and even some Democrats is that nothing should come between us and our Doctors.

And now, here we go again. A so-called independent panel called the US Preventive Services Task Force is recommending a drastic change in the guidelines physicians use to order mammograms for their female patients. Although this panel is toted as being “independent”, it is sponsored by a branch of the Government. Having myself been on many panels and committees during my career, I remain leery of anything emanating from such deliberative bodies. A friend of mine was fond of saying that committees don’t create, they just procreate. The spokesman for the panel, Dr. Timothy Wilt, stands by their widely disseminated recommendation that “most women” don’t need to get an annual mammogram beginning at age 40, the long held position of the American Cancer Society, but instead, should get a mammogram every 2 years starting at age 50.

That’s a wow!

To quote another friend of mine: “I don’t impress so easy.” I find myself particularly unimpressed when noting that the Dr. Wilt is on the staff of the Minneapolis VA hospital, a fine institution by the way, but not one where one might get a lot of experience managing female breast cancer. Moreover, his main area of expertise is the area of PROSTATE CANCER. That’s a double wow!

Had that recommendation come from some guru with a lifetime of experience in the management of female breast cancer, I’d give it some thought, but in this instance, I can only laugh; bitterly.

Here’s the deal, gentle reader:
1) Heredity is an important factor for breast cancer. A patient with one first-degree relative (mother, sister, or daughter) with breast cancer has about twice the risk of developing breast cancer. With 2 first-degree relatives her risk increases about 5-fold. Under these circumstances, mammograms would be appropriate much, much earlier than age 40.
2) Women should realize that the single most important risk factor for breast cancer is OBESITY. Weight specialists define obesity for women as having a body mass index of 27.3 or more. (Check. my posting on the subject). Since the prevalence of overweight and obesity among adults 20–74 is now 65 percent, would it not be highly appropriate to start ordering breast imaging studies long before 50; in fact during the early thirties when overweight sets in, often with the first pregnancy?
3) It has been shown that cigarette smoking plays an important role in the etiology of breast cancer, especially if heavy and started early in life. One shouldn’t wait until 50 to get a mammogram if the patient is a smoker.

Because the number of risk factors for breast cancer in women is so long and complex, I could go on and on, had I the space. But perhaps I’ve made my point. The Government should not interfere in these matters but leave these important decisions to the patient and her doctors.

And believe me gentle lady reader: If this so-called public option goes through, you VILL VAIT until you’re 50 to get a mammogram; or if you really, really want one you could go to India.

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