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Playing Politics With Cancer

Playing Politics With Cancer

Normally I’d be thrilled to see women’s health issues make the cover of the New York Times two days in a row, but given the circumstances, I’ll pass.

Coming up right behind the U.S. Preventive Services Task Force report recommending an end to baseline mammograms for women under 50 is news that the American College of Obstetricians and Gynecologists recommends women delay their first Pap test until age 21, and then screen every-other-year rather than annually.  If a woman is 30 and older and has three consecutive Pap tests that were normal and has no history of seriously abnormal findings, those screens can stretch to three-year intervals.

Pap smears, similar to mammography, are screening tests designed to detect the presence of abnormal cervical cells.  Such cells are often precursors to cervical cancer.  Cervical cancer is caused by a sexually transmitted and virtually omnipresent virus human papillomavirus, or HPV.  Only some people who are exposed to HPV develop cancer, and for those where cancer does develop it can take 10 to 20 years after viral exposure to manifest.

Based on the same justifications as the USPSTF report, this advice is meant to decrease unnecessary testing and potentially harmful treatment, particularly in younger patients.  Doctor advocates supporting the new recommendations argue that the change in Pap screening is more compelling that the change in mammography because there is more potential for harm from the overuse of Pap tests and because as a disease cervical cancer grows very slowly, giving practitioners plenty of time to catch the disease between screenings. 

It’s clear that there is a risk of harm in action based on early intervention as a result of abnormal Pap results in some cases.  Frequently young women develop changes in cervical cells that if left alone, go away.  But because all cellular change appears to be precancerous, and because cervical cancer is an especially lethal form of cancer, when faced with an abnormal Pap result doctors often perform surgery to remove the cells.  Those procedures can inadvertently damage the cervix and lead to problems later if a woman becomes pregnant, including premature birth and an increased risk of needing a Caesarean delivery.

So that’s the science.  But what about the politics?  Perhaps it is simply a case of unfortunate timing, but what should be a difficult but informed decision on setting women’s health policy has become so inextricably intertwined with the attack against health care reform that it is nearly impossible to react to these reports with anything other than suspicion.  As pointed out in Ann Pietrangelo’s critique of the mammography guidelines, even if the reports fail to influence policy makers in Washington they will undoubtedly have the effect of influencing insurance providers, thus making the availability of potentially life-saving screening devices even scarcer. 

But that’s the private sector–that is NOT the government rationing health care.  And that is an important distinction to make.

It is the inefficiencies inherent in the current insurance model that will make screening tools less available, not any potential-yet-unformed health care reform.  These guidelines, and hundreds of others like them that receive far less political attention, are meant to drive doctor’s differential diagnosis, not dictate individual care.  At the end of the day, in an ideal world, these recommendations would be nothing more than another arrow in the quiver of doctors and patients deciding individual care options.  That the tests are not affordable, and that it is actuarial analysis more than clear-cut science forcing the health care industry into this kind of standardization says more about the problem of keeping health care in the for-profit market than anything else.

And that this is the context of the debate shows just how far off the rails the Republicans and a lot of Democrats have taken health care reform.  Once again the concessions, the politics, all come at the expense of women having simple, affordable access to screening devices when it is appropriate.  Doctors may or may not follow the recommendations, but deviation will depend on a lot of measures, and is is the insurance industry, not research task forces, dictating those measures.  From setting standards-of-care for tort claims or actuarial support for denying payment for a procedure, make no mistake about it, it is the insurance industry driving this problem.

But Congress certainly isn’t helping.  Those who gave full-throated support of Stupak-Pitts and applauded the systematic stripping of women’s equal access to current health insurance products are decrying these reports as evidence of the beginning of government rationing of health care.  Really?  Is it so difficult to see the disconnect there or does it just not matter because at the end of the day these representatives are debating about procedures that remain for them at best theoretical.  Whatever the conclusion, the one thing becoming clearer and clearer is that, in our current political and cultural climate, women’s health remains optional, expensive, and political, regardless of who drives the debate.

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photo courtesy of euthman via Flickr

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58 comments

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11:28AM PST on Feb 14, 2012

I have had cancer several times and in the beginning I experience spontaneous remission. Since then through an understanding of what it's about I have stimulated such remission. Now I know how to "stage-manage" my biology so I do not develop cancer. I have found that cancer is all about stem-cell mediated immunity, erroneously ignited because the person is under attack through toxic relationships and the presentation of harmful ideas that they mistake for their own. Often such ideas are barely conscious. The action of mirror neurons in the brain causes a person's body to believe it is under a real attack and the only method is to shield itself hence the growth of cell shields.. a cancer mass. I have started a blog at http://kyrani99.wordpress.com/ and a website at http://kyrani99.doodlekit.com/home to raise awareness and help others to effect spontaneous remission as I have done. It is easy. And I am willing to answer people's questions if you leave messages for me at my blog or email me at ani.eade@yahoo.com.au or ani.eade@mail.com

4:39PM PST on Nov 24, 2009

The US system is different from Australia that has a socialised system, not as good as Scandinavia though, but what's clear is that as has been mentioned, firstly, the fact that women's reproductive systems are far more complex than men's is not given enough weight, but also obviously choices re preventative measures are being made for economic and not health reasons - oh what a shock!

6:07PM PST on Nov 23, 2009

What is happening with the US health policy? Have they been studying what could be the impact to the women who need most of health care. They can even be daughters, mothers or future mothers of the next American generations.

4:31PM PST on Nov 23, 2009

Just occurred to me, too: making sure a lot of cases of cervical cancer wold be a hellofan advert for the vaccine that no one wants anymore...

Ian

4:26PM PST on Nov 23, 2009

These people are so damned disconnected from the voters it's like a monk trying to run a sex therapy clinic. They have NO business making laws for us - they have no understanding of life without the backing of millions of dollars in the bank and total medical coverage. They keep trying exclude SOMEbody - women, elderly, pre-existing conditions and on and on, or to exclude specific procedures or medications. It's high time we got civilized and made medical are, PERIOD, a human right. If we can throw away TRILLIONS of dollars to steal from other countries, we can damned well spend a few billion on healthcare! We just need to keep voting these ivory tower idiots out and voting in people who've been there and seen what real life is like, at least. Eventually they'll get the idea.

Ian

Ian.

2:53PM PST on Nov 23, 2009

I wish the government would remember women is the giver of life and should be treated as such.

Age has no place when to receive a Test, Treatment, or blamed for every thing that is wrong in the world.

5:04AM PST on Nov 23, 2009

Oh, and by the way, most work in this field is carried out by women, so the comments about getting old white men out of government is more than simply in bad taste, it is utterly misleading and dangerous as well, we, as men, spend far more time and money looking after womens problems than we do our own, which we mostly ignore, and when we come to personal spending in the home, the women account for 85% of all expenditure on a personal basis, name me any man, who has more than a couple of suits, or dozens of pairs of shoes, for every outfit, or handbags by the truckload, as "posh spice" has a wardrobe of £1.5 million pounds worth of handbags alone, ( about $2.25 million US dollars worth, he, "David Beckham", has barely a drawer full of tracksuits ), or spends a fortune in dribs and drabs, or make up, or pesonal items
So women of the world unite, and do and say something that tells us you actually care about us, as much, if not more than yourselves, just this once, say, and do something, about male cancers first, instead of complaining about a womens only problem, yet again, ( and yes,! I know men get breast cancer, but it remains a womans problem mostly ), but lets get the "I hate men brigade" off this posting, because right now, this is what I am reading , and it just seems pure and selfish, that yet again underfunding of male cancers research and treatment, on a massive scale, is not even getting a word in edgeways....

Just how self centred are women any

4:46AM PST on Nov 23, 2009

There is no evidence that organic eating is any safer, against cancer than everyday consumption, it is just another do gooder, holier than thou, position, accepted as gospel without any evidence whatsoever.
But while I am here, let me also say that there is a major disparity between the sexes here, and men miss out on funding for prostate cancer by factor of six times as much being spent on breast cancer research and funding that women recieve, as against a minor amount on male cancers in total.

Leap up and down in outrage if you like, every time this breast cancer problem gets mentioned in the papers, or on T.V. but lets not forget that men die in even greater numbers of prostate cancers, than women die from breast cancer, and if you must campaign , do not do so, as if this is all that matters.....or is unfair....that is where your rage should be aimed at......

3:09AM PST on Nov 23, 2009

There IS a way to PREVENT cancer, and mammograms are NOT it. Eat organic (many cities have markets with very affordable organics); learn about your food--don't eat GMOs; eat unrefined and unprocessed foods; use good unbleached (black and red) sea salt that has NOT been bleached--we need to iodine to help prevent us from getting cancers and other diseases. Our traditional doctors are NOT telling us the ways we can prevent the many diseases growing in our country. We need to learn about our food; see the movies Food Inc. and Fresh. We need to avoid chemicals in our home. We need to write letters to politicians and inform our friends and family. Thermography is a much safer and effective means of detecting cancers than mammograms. I've lost too many family members and close friends to go that same route--we need a food and health revolution.

8:32PM PST on Nov 22, 2009

People need to wake up!!!! You need to be proactive about our health and it is crucial to get a mammogram every year for a woman. I'm 30 years old and I just got diagnosed with breast cancer two days ago. I have a 5 cm tumor!!! Age is not an issue but our environment is. I have no family history of it either. So you can moan and groan about being poked and proded but I bet you'd change your opinion in a heartbeat if you were in my shoes! No amount of prayer or meditation is going to detect your cancer(or cure it). There is no substitute for routine screenings no matter how invasive they are.

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