Thursday, December 3, 2009

Less Cancer Screening is a Technocracy, not Discrimination

To be very clear about this, there have been nearly equivalent studies showing that early prostate cancer screening doesn't do much to reduce prostate cancer mortality. No one said anything about these studies giving men an excuse to take the a heteronormative "tough it out" approach and avoid seeing a doctor. Dana Milbank didn't write columns with quotes from stunned advocacy and awareness groups. Prostate cancer survivors in the Senate like John Kerry and Chris Dodd didn't demand amendments that mandated full first dollar coverage for current levels of PSA screening (in fairness, Senator Mikulski has rolled back the language to allow the hope of some flexibility hear, if at some point the relevant agency can change their recommendations without creating a firestorm on Capitol Hill or in the White House). Tom Coburn didn't start making shit up about how the Democrats would tax your ... well, I think my readers have gotten the picture.

America has two problems relating to breast-cancer screening. One is the inequity in access to screening; poor and/or non-white women are less likely to get screening than middle-class and/or white women. The other is that those women who do get screening receive frequent and early screening that ends up detecting a larger number slow-growing, non-fatal than peer countries. In addition, mammograms in general produce a lot of false positives, so we're putting lots of patients through a lots of anxiety and unpleasant treatment that's not saving very many, if any, lives. In the UK, women at standard breast cancer risk (no BCRA, no family history of breast cancer) are guaranteed one mammogram every three years starting some time between 50 and 53 (women at elevated or high risk are guaranteed US levels of screening). France (which has the #1 quality health care system in the world) offers breast cancer screening starting at age 50 every two years. Germany? Same as France. The rest of the industrialized world seems to think that the harms caused by early screening—and let's be clear on this, complications due to treatment of a non-fatal cancer are definitely harm—outweigh the benefits. This isn't discrimination, this is going where the evidence is taking us. Yes, that line has abused by pro-discrimination types throughout history. But that doesn't mean that every time it's used, there's discrimination afoot.
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