Mammogram ruling restores human factor

As with most medical issues these days, the question of how often women ought to have tests for breast cancer is not just a matter of good health. It's also a question of money.

Controversy has swirled this year around the subject of mammograms to check for breast cancer. The debate has focused on when women ought to start having them and how often they should be repeated. And the bottom line in the standards that influence insurance company guidelines has been the profit margin of cost-benefit analysis.

Since 1993 the National Cancer Institute's official position has been that there was not enough evidence to justify the expense for women in their 40s to have mammograms. Studies of whether mammograms for women before age 50 actually save lives have been indecisive. Mammograms cost up to $150, and as many as 90 percent of the abnormalities they uncover are benign. Of the 44,000 deaths anticipated this year from breast cancer, only about 10 percent are expected to be under age 50. In relation to the number of lives lost, the expense of such widespread testing didn't measure up.

Health care trends

Cancer advocates, including Sen. Kay Bailey Hutchison, were outraged. Such cost-benefit analysis is exactly the kind of financial tyranny that we all fear from current trends in health care. Reducing people's lives to dollars and cents is a terrible form of dehumanization.

And why include only fatalities in the cost-benefit equation? What about the disfigurement of breast removal, for example, for women in their 40s whose cancer was detected soon enough to save their lives but not to keep their bodies intact? What about the psychological effect on those women and on their husbands and families?

But without government prompting or intervention, insurance companies are free to choose for themselves whether to pay for women in their 40s to have mammograms. Fortysomething women without insurance, or with insurance that won't cover the test, have to pay the cost themselves, if they can. Women and their own doctors have been left to decide for themselves whether their expense is worth the benefit.

Changing the picture

Thursday's announcement by the National Cancer Advisory Board that women in their 40s should get mammograms every one to two years changes the whole picture. The board advises the National Cancer Institute, which is expected to quickly adopt the new guidelines. That will immediately put pressure on the insurance industry to pay for mammograms. In fact, Congress is already discussing ways to force private insurers and Medicaid to pay for women in their 40s to have the tests.

Breast cancer strikes some 180,000 women each year. Those women don't see themselves as mere statistics on some medical insurer's balance sheet. Neither do their loved ones.

Thursday's declaration puts part of the human element back in a health care system that seems increasingly driven by the almighty dollar.