by Constance Uribe, MD
It is common knowledge that over 500,000 Americans die from cancer every year. Americans have become increasingly conscientious about the concept of early detection as it pertains to breast and prostate cancer. One in six men will develop prostate cancer, and about one in eight women will be diagnosed with some form of breast cancer. Eighty-five percent will have no family history.
We have improved the survival of breast cancer patients, especially in those who are diagnosed before the age of 50. While it is true much of this success can be attributed to improved treatment regimens, early detection through screening mammograms has played a major role.
Many elderly men have undiagnosed prostate cancer. It has been estimated 70 to 90 percent will have malignant cellular changes in their prostates by the age of 80. The prostate-specific antigen blood test can save an estimated 17,000 men every year from presenting with the disease in an advanced stage.
The federal government has once again driven a wedge between patients and physicians by creating its own criteria for the screening of these two prevalent malignancies. Instead of trying to improve on something that was working pretty well, Washington decided to scrap the idea because it did not fit the current agenda.
Our own government is avoiding early diagnosis and treatment of these two known killers, turning a blind eye as these malignant terrorists invade our bodies. Only Washington could take something as straight forward as cancer screening and turn it into a complicated quagmire, and a deadly one at that.
These bureaucrats recruited members of my own profession to fall back on the Hippocratic doctrine of “first, do no harm.” To use simple examples: A physician should not order a mammogram, even if he can pick up an early cancer, because the mammogram is radiation and that is dangerous. Also, he should not order a prostate-specific antigen test on a patient because it might turn out “positive,” and the patient might have a side effect from the treatment. That would be bad.
This idiocy began with the United States Preventative Services Task Force, an organization created by the U.S. Department of Health and Human Services. The task force is composed of primary care physicians and epidemiologists to make recommendations regarding clinical preventative tests. It would seem their assignment was to come up with reasons to deny clinical preventative tests, such as mammograms and the prostate-specific antigen.
The panel members came to the conclusion physicians would “overdiagnose” and “overtreat” early, indolent breast and prostate cancers. If left alone, these tumors may not develop into more aggressive forms until much later. They also suggest we work on finding genetic testing to discover which of these tumors fit this indolent category, yet there is no recommendation to continue early screening until then.
According to our government, only women above the age of 50 are to have screening mammograms, and then only every other year. A younger woman would qualify for a mammogram if she had a mass that was large enough to be palpable. By then, her stage and treatment options would be different, and the same task force concerned about “overtreatment” would be subjecting this patient to modalities fraught with more
Likewise, the task force reports the prostate-specific antigen shows no benefit for diagnosing prostate cancer and claims the risks outweigh the benefits. The American Urological Association has an entirely different opinion. This organization, made up of specialists, believes ordering the prostate-specific antigen test results in a reduction of the number of men presenting with the advanced form of the disease.
According to Dr. Edward Messing at the University of Rochester Medical Center in New York, many more men will present with far advanced prostate cancer if physicians stop doing the prostate-specific antigen test. “Almost all men with clinically apparent metastases (spread) at initial diagnoses will die from prostate cancer,” Dr. Messing explained.
How does Obamacare come into play here? Under the Affordable Care Act, the same medically challenged agency which created this task force will be the one overseeing the healthcare of this nation. The Secretary of Health and Human Services will have the final word on all the rules and regulations regarding the distribution of health services, and those will include the ones related to preventative care.
I foresee the day when physicians will not only have difficulty ordering screening exams on their patients, but they will be penalized if they do. Health and Human Services will take the screening recommendations from this task force very seriously, and the agency will enforce them. Even if Congress attempts to pass legislation overriding any of the regulations, Health and Human Services will still have the final word.
President Obama, the Secretary of Health and Human Services and Congress have no major investment in the new cancer screening guidelines. They will be getting mammograms and prostate-specific antigen tests whenever their doctors recommend. It’s not about them and their husbands and wives and sons and daughters. It’s about you and yours.
Dr. Constance Uribe is a general surgeon and author of “The Health Care Provider’s Guide to Facing the Malpractice Deposition” (CRC Press, 1999).
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