Bob Kemp
Who will you trust with your health? Your doctor or the government
By Bob Kemp
December 10, 2009

About three weeks ago the U.S. Preventive Services Task Force (USPSTF) updated their recommendation concerning how often women should be screened for breast cancer, at what age women should begin such mammogram screening and tossed out the window women performing self exams. This created quite an uproar among health care professionals, the America Cancer Society and regular people in general because this was a 1800 turn from the USPSTF's recommendations made only a few years ago that were whole-heartedly at that time endorsed by the groups I just mentioned earlier. The uproar has died down, but the concerns are still there among critics of the current health care reform bill. The original recommendations just make better sense to everyone concerned. Earlier detection of breast cancer usually results in more positive outcomes for the patient and lower cost to both the patient as well as the insurance company.

White House Communications Director Daniel Pfeiffer had harsh words for those that criticized the new guidelines which recommend against annual screening for breast cancer for women under 50 years of age. Stating that the revised guidelines are only recommendations and that the USPSTF has "no power" to deny health care coverage, Pfeiffer admitted, "Their recommendations would be used in health reform to identify effective clinical preventive services." This influence is of considerable concern to critics as the Congress is considering sweeping changes which will in effect turn over 1/6 of the U.S. economy to be run by the government, a government that already has control of 2/3 of the American automotive industry as well as considerable interest in the banking industry. Pfeiffer also commented at the time, "While the bills are still being drafted and debated in Congress, health insurance reform legislation generally calls for task force's recommendations to help determine the types of preventive services that must be provided for little or no cost. Their recommendations alone cannot be used to deny treatment." They may not be able to be used to deny treatment, but notice that cost does play a factor even though the USPSTF has insisted that cost of such preventive testing was not a factor in its assessment of breast cancer screening despite the fact that cost was referred to at least 3 times in the panel's report. Also, HHS Secretary Sebelius countered what the USPSTF recommended and said women should continue self exams as well as early screening through mammograms beginning at the age of 40. I am hearing a lot of double-talk coming out of Washington on this issue. What say you?

If the health care reform bill presently being debated in Congress is passed, one has to ask if this recommendation would be the beginning of health care rationing for all American's. According to Republican Rep. Marsha Blackburn in an e-mail sent to "This is the way rationing, which my colleagues and I have warned about, will begin to enter the market place — slowly, imperceptibly and lethally." Because of the fact that breast cancer is the Number 2 cancer killer among women, we should all be very concerned about any guideline changes the influential USPSTF comes out with that fly's in the face of not only common sense, but practicality and proven past results.

I recently had the honor and privilege to interview Dr. Cynara Coomer on this subject. Dr. Coomer is an Assistant Professor of Surgery at Mount Sinai Hospital in New York. Specializing in Breast Health and Surgical Oncology, Dr. Coomer is also involved in community awareness about breast disease. She is a health Contributor to Fox and where her clinical research and news reports are focused around women's health, specifically breast cancer and breast health at all ages.

I asked Dr. Coomer her opinion on how the new guidelines from the USPSTF may affect women's health. She responded by stating "Not only will we see an increase in the number of breast cancer deaths especially in young women because that's where they will be missed, we will also see it in the elderly with their recommendation to stop mammograms at the age of 74. We will also have cancers diagnosed at a much later stage which would mean an increase in the amount of treatment that they would need. So they would need much more aggressive treatment such as the addition of chemotherapy, and/or radiation in situations where they would not if the same cancer had been diagnosed at an earlier stage."

Dr. Coomer also stated that the difference between early detection and late detection of breast cancer is "night and day" and added "First of all, if a patient is diagnosed at stage one they basically have multiple surgical options. Depending on the type of surgery they have, they may not need to have radiation. And then they usually do not need to have chemotherapy at stage one, and at early stage two. Beyond that, surgical options become restricted if you're diagnosed later. In situations where the surgical procedure wouldn't ordinarily require radiation in early stages, it may require radiation at a later stage as well as chemotherapy...the difference in the treatment between early stage and late stage is significant. In addition to that, the prognosis for cancer diagnosed between early and late stage is dramatic. At stage one survival outcome is around 96% over five years, whereas at stage four cancer the survival outcome is 25% over five years."

This is as Dr. Coomer stated a very significant and dramatic difference that affects the lives of breast cancer patients and their families at multiple levels. You have to wonder about the people sitting on the USPSTF panel and whose better interest they are attempting to protect; yours or the governments? Look again at the percentages and you can understand why Dr Coomer believes we will see an increase in the number of breast cancer deaths over time if people put their faith and trust in the USPSTF panel's recommendations.

When asked if she found the panel's guidelines alarming when she first learned of the changes, Dr. Coomer told me "Not only do I find them alarming; I found it very puzzling that the Task Force would come up with these recommendations. The Task Force is made up of a group of Primary Care Doctors and insurance representatives, and not one panel member is a breast surgeon or Medical Oncologist or Radiation Oncologist or anybody that specializes in this area. Nor did they apparently seek the advice of anybody in this area."

I found this to be an amazing and disturbing revelation that the USPSTF panel is making recommendations in areas that nobody on the panel would be considered an expert in. By stating the panel is made up of doctors, the government is attempting to build up public confidence in the panel's recommendations, all the while knowing not one expert in the field serves on the panel. Can you see the deception at work? Would you take the advice of your family doctor on how to treat a stage three cancer, knowing she is not an expert in Oncology, or would you seek out someone that specializes in that field? The answer to me is an obvious one.

Dr. Coomer said the panel "may have come up with this information from a recent study that came out that said that we are over-treating and over-diagnosing breast cancer at earlier stages, which is true. We are over-treating some of these findings on the mammogram. But for 7 to 10 patients we are over-treating, we are saving a life. To me that means something because every life is worth something, and at this point we don't have a better test than the mammogram, so we have no other option for these women. It just doesn't make any sense to throw the baby out with the bathwater so-to-speak because of that concern. Until we have another alternative, this is the best we have and we should be utilizing it."

Dr. Coomer went on to explain to me that statistics show that one life is saved in every 1300 women between 50 and 59 that have mammograms that do not need the mammogram, and one life is saved in every 1900 women between 40 and 49 that have mammograms that do not need them. Dr. Coomer and I both agree that for all those women who had the mammogram screening performed and that the test came back clear, the peace of mind in being told this from their health care professional is well worth having and far outweighs any inconvenience they may have gone through at the time of the screening. As a specialist in women's breast health, Dr. Coomer can see no reason for the panel's recommendation especially in light of the fact that over the last two decades we have seen a 10% decrease in breast cancer deaths due to early detection, at least not until there is a better way of testing for any women at any age.

Dr. Coomer also added "The point of screening is to be able to offer a test to the general population that can red flag certain people and then you just proceed from there." Dr. Coomer said she is telling her patients that they need to continue to follow the American Cancer Society's guidelines for self examination and to start having mammograms at the age of 40 on a yearly basis and possibly at the age of 35 depending on their own personal risk factor. She also recommends that women over the age of 74 should continue to have yearly mammograms probably until the age of 75 and then discuss with their physician as to whether or not they would benefit from to going to every other year.

I want to thank Dr. Coomer again for taking time out of her busy schedule to answer a few questions on this topic and share information and advice with us all. I'm sure you will agree that Dr. Coomer's comments are invaluable because of her years of expertise in the field of women's breast health and we are all the wiser for listening to her.

At the end of the day I believe my question at the beginning of this column is still a valid one. Will you put your trust for your health in the hands of a well trained and experienced health care professional that has your best interest at heart like Dr. Coomer? A competent, knowledgeable and experienced doctor that practices freely without government oversight and involvement and can make available to you all the resources and expertise needed in order for you to have a fighting chance at a full recovery from your illness? Or, will you place not only your future, but the future of loved ones in the hands of a doctor that takes their orders from a distant, uninvolved and dispassionate government panel in its ivory tower who cannot even agree with their HHS superior about what is best for you. If the folks in Washington that want to take over health care get their way, you may have little or no choice in the matter. Change will be incremental, and some may not notice the rights or freedoms of choice being manipulated and taken away concerning health care, at least, not for a while. Not until their doctor tells them they need a test to be screened for a certain cancer, but the test will not be available to them for several months, as is the case in Canada, England and much of Europe. If this is the kind of incompetent and risky health care you want for yourself, your elderly parents, your young children and your spouse, then do nothing, say nothing. But do not complain as your health or the health of a loved one is diminishing before your eyes solely because the medical treatment they need is being withheld because you or they do not fit into a particular demographic that was predetermined by a medical panel in Washington that probably didn't even have an doctor sitting on it that was an expert in the field of care you need. But if you are not in favor of government run health care, then make some noise and let your elected representative hear from you loud and clear that they will be out of a job in 11 months if they vote yes to government run health care. To do anything less is irresponsible and lazy.

To read the American Cancer Society's stand on this issue, follow this link There is a statement on the home page.

© Bob Kemp


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Bob Kemp

Bob Kemp, an ordained Deacon, husband, father, and Sunday School Teacher, currently works as Concert Coordinator for a multiple Dove Award winning and Grammy Nominee Contemporary Christian Artist at Praise Ministries in Lindale, TX... (more)

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