Is Your Mammogram Worth the Price?

When two people mention the same thing to me within a week, I know it’s time to take notice. This time it was 3-D mammograms (aka digital breast tomosynthesis). Hospital radiology departments and mammogram centers are marketing them as if they were the new female Viagra and yet. . . we don’t yet know if the risks are worth the benefits.

A traditional mammogram consists of vertical and horizontal images. The 3-D mammogram, as its name implies, provides a more holistic view as it swings in an arc around the breast, then combines those pictures into a three-dimensional image just like a CT scan. Studies find that combining the two may reduce call backs for additional tests and improve cancer detection rates.  Overall, the National Cancer Institute reports, about 20 percent of breast cancers are missed during mammography and about 10 percent of women get called back for further screening.

I first heard about 3-D mammography during a dinner party, when a friend announced that she’d been diagnosed with early-stage breast cancer (actually, she’d been diagnosed with ductal carcinoma in situ [DCIS], which is not technically cancer). If it weren’t for this amazing … Continue Reading

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Want to Reduce Cancer Deaths? Give Everyone Cancer

I stole that headline from an amazing op-ed in Thursday’s The New York Times written by the co-author of what will likely be one of the most provocative medical studies published in years.

For their study, published online last week in The New England Journal of Medicine, the authors used trend data from the National Health Interview Survey on the proportion of women 40 years of age or older who underwent screening mammography, then compared those numbers against data on breast cancer incidence and survival rate.

They found that 1.5 million more women have received a diagnosis of early-stage breast cancer since the introduction of screening in the 1980s, but there was no change in the number of women with life-threatening metastatic breast cancer. This means that screening, which, as the authors point out, is touted as one of the most important thing women can do for their health and credited with saving millions of women from death from cancer, is neither. Plus, the data they relied on was produced before today’s more advanced mammography techniques, which are capable of picking up even earlier cancers.

So how to explain the drop in breast cancer deaths over the past 30 years … Continue Reading

cancer mammograms

Five Reasons Why Privatizing Medicare is a Bad Idea

We now interrupt our regularly scheduled programming to bring you a wonky blog post. 

So a few people out there are suggesting that we privatize Medicare and give out vouchers for recipients to purchase their own insurance on the open market. This is such a bad idea for so many reasons, and shows that some people simply don’t understand how Medicare works. Here are my top five. . .

1. Medicare is the closest thing we have to a single payer system. Medicare covers one in seven Americans, 97 percent of those 65 and older., or 49 million Americans. In 2030, the number of Americans covered is expected to nearly double, with one out of five Americans covered.

This huge cohort of individuals provides enormous opportunities to test  new reimbursement and quality initiatives with a large cohort. In fact, Medicare is leading the country in many of these initiatives, including accountable care organizations, pay-for-performance options, DRGs for hospital reimbursement (which reimburses based on diagnosis, not on how many aspirin you get), and financial penalties for hospitals if patients with pneumonia, heart failure, or heart attacks are readmitted within 30 days. Those penalties are expanded to vascular surgeries/procedures in 2015.

… Continue Reading

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The TRUE Cost of Health Care

Medical Records & StethoscopeThree years ago, my husband left his perfectly secure job (read: with benefits) and became a full-time consultant for his old company (read: without benefits) so we could have a much nicer lifestyle in Williamsburg, Va than we did in the small Pennsylvania town in which we’d lived for nine years (no offense to Pennsylvanians, but I’m a Virginia born-and-bred gal and I needed to get back to the Commonwealth, where the daffodils bloom in February and we can wear flip flops before June).

Needless to say, we lost the benefits (read: employer-provided health insurance) that had allowed me to go out on my own as a freelance medical writer seven years before.

No problem, I thought. I’m a healthcare expert. Heck, I once managed the provider relations department for a mid-sized managed care company, contracting with doctors and convincing them that they hated our HMO less than the other HMOs in the area (I was pretty darn good at it, too). I’ll just go out and find us some health insurance.

I started on the individual market. For my sons … Continue Reading

health insurance healthcare reform high-deductible health plan mammograms

The New Mammogram Recommendations

I have one word for those who are freaking out over the United States Preventive Services Task Force’s new mammogram recommendations suggesting that most women in their forties should not undergo  regular screening mammograms.


Good lord! You would have thought the task force recommended witholding treatment from any women in her 40s who had breast cancer, or banned her from getting a mammogram, or threatened to jail any insurance company that had the nerve to pay for said mammograms.

Could we all please take a breath and look at the facts for a moment?

Fact. The USPSTF is just one of three major bodies (including the National Cancer Institute [NCI]  and the American Cancer Society [ACS]) that releases screening mammogram guidelines. The ACS has already said it has no plans to change its recommendation that women in their 40s have regular screening mammograms; the NCI is reviewing the data. Fact. The issue of mammograms for women in their 40s has been controversial for decades; the USPSTF has updated its recommendation based on new evidence. Fact. The USPSTF did NOT consider any economic data in making the new recommendation–only scientific data. Fact. What is appropriate for a large population … Continue Reading

health insurance healthcare reform high-deductible health plan mammograms