Health Minister Responds: Mammogram Services
The Minister of Health, Seniors and Environment Jeanne Atherden today [May 27] responded to the statement on Mammogram services by the Shadow Minister of Health Kim Wilson.
Yesterday Ms Wilson expressed concern over proposed health insurance legislation as it pertains to mammograms, saying that “rather than rushing through this important legislation, we call on Minister Jeanne Atherden to pause and gather statistics relevant to Bermuda” as “skipping a year of mammograms could cause death by delay.”
In a statement today, Minister Atherden said,“The Government is not introducing legislation telling Bermudian women they can only have a mammogram once every two years and it is misleading to suggest that having mammograms once every two years will cause death by delay.
“The said amendment in the Health Insurance [Miscellaneous] Amendment Act 2015 seeks to ensure the coverage for Bermuda’s minimum health insurance package – the Standard Hospital Benefit [SHB] is grounded on evidence-based medicine, and in line with international best practice, with respect to screening mammography. Women with a family history or other risk factors will still be covered for testing with a physician referral at any age. This amendment seeks to assure that women obtain physician input in the decision to use this technology in young ages where the science indicates that the benefits do not outweigh the risks.
“Currently, the health system in Bermuda informally follows the American College of Radiology guidelines for mammography which recommend annual screenings for women aged over 40 years. A clinical review of various international guidelines from several countries has proposed changing the Bermuda standard to follow the United States Preventive Services Task Force [USPSTF] Guidelines which recommend that healthy, asymptomatic women aged 50 to 74 years be screened every two years.
“The USPSTF Guidelines are recommendations which review, analyze, interpret and then report the evidence from a multitude of studies conducted by international subject experts.
“The recommendations are agreed upon using a robust methodology by a panel of esteemed physicians and researchers representing a variety of fields. The Task Group has a rigorous screening process to assure the members have no substantial conflicts of interest which would bias their opinions. Although the members represent multiple disciplines, all scientific fields cannot be represented on the Task Force for practical purposes.
“The Task Force is comprised of scientists and medical experts on prevention. The decisions are made purely on scientific analysis of the harms of over-diagnosis and the benefits of early detection. As in all aspects of science, there is never perfect consensus on any topic among even the experts; likewise there is variation in the opinions around screening mammography
“Locally, physician leaders from the Bermuda Medical Doctors Association, the Bermuda Medical Council, and the Bermuda Hospitals Board, support the recommendation in addition to the Bermuda Health Council. The USPSTF was identified as a reasonable set of guidelines for our health system as they are moderate in nature, falling somewhere between the recommendations of individual specialty groups in the USA [such as American College of Radiology] and the UK’s National Institute for Heath and Care Excellence [NICE] guidelines. It is important to note again that unanimous agreement on a standard is not a realistic expectation. But the standard of evidence provided by international studies has produced international consensus on the benefits of starting screening at age 50.
“Any woman with an immediate family member with the disease, dense breasts or who have used hormones after menopause for five years, plus other risk factors known to the patient and her physician, will have full access to all mammography coverage necessary, as they do now.
“The decision of when to screen or not with mammography should be made by a woman and her physician, after consultation together.
“Starting screening mammography at 50 is recommended by international leading agencies and experts. Bermuda considered clinical guidelines from the US, the UK and Canada which ranged from annually from age 40 to every three years from age 50. The decision to use the USPSTF guidelines was based on the fact that international studies have found that annual screening for women with no symptoms and no risk factors leads to over-diagnosis, which results in repeated exposure to low levels of radiation and unnecessary treatment. The guidelines are highly credible and based on extensive meta-analyses of international studies.
“There is no local study to support the notion that Bermudians of African descent might benefit from earlier detection, and neither of our guest prevention experts [Dr. Welch or Dr. LeFevre], nor the physician representatives collaborating in support of adherence to USPSTF Guidelines, are aware of any study data that support improved outcome and less harm from “over-diagnosis” in such a sub-population who are systematically screened earlier.
“It’s imperative to remember that these are screening procedures for women with no symptoms, no family history and no risk factors. Black women in Bermuda who do have a family history or specific risk factors will be referred for mammography by their physician and it will be covered under the standard health benefit. The legislative change clearly states that it is covered outside the guideline if there is a physician referral. Any insured woman at any age with a family history or other risk factors known to the patient and her physician will have full access to all mammography coverage necessary, as they do now.” Minister Atherden concluded.
- Statement amended at 1.14pm
How many more times is the OBA going to have to correct the misinformation that the PLP spreads? This again is another one of those times.
You mean how many times is the U.B.P/oba going to correct their F!@#ups every time they rush to mske a decision
Wrong again. The Minster has explained that no woman loses coverage. You can read. I’m sure you can.
In a statement today, Minister Atherden said,“The Government is not introducing legislation telling Bermudian women they can only have a mammogram once every two years and it is misleading to suggest that having mammograms once every two years will cause death by delay.
translation…
You can have a mammogram every Tuesday, or once a year between the age of 40 and 50, but the insurance company will only pay for it under stated parameters…
Following probably covers all suspicions, and answers all questions. I thank you Minister of Health, Seniors and Environment Jeanne Atherden for the clarifications you’ve presented the public on this extremely important topic…
Note:
“Any woman with an immediate family member with the disease, dense breasts or who have used hormones after menopause for five years, plus other risk factors known to the patient and her physician, will have full access to all mammography coverage necessary, as they do now.
“The decision of when to screen or not with mammography should be made by a woman and her physician, after consultation together.”
As usual the OBA response is longwinded and the message will be lost.
It’s THOROUGH!
LOL
Every single piece of PLP legislation was badly drafted but rushed through the system.
How quickly you forget.
@aceboy: As we’lot say, “ain’t dat de troof”
Same shhhhitttttt different day!
It’s just PLP politricks in effect. AGAIN. Anything to stir the pot of voters emotions based on misrepresentations and lies. For some reason I thought Kim Wilson might be better than that. Ha! Ha!…Nope!
I had been having a Mammogram yearly and in 2003 I had a mammogram a shadow was seen it was discovered to be breast cancer stage 3 and I continue to have a mammogram every year with a bone density test every three years
Good on you, Minister Atherden! Hit them with facts and science.
Reality is our healthcare costs are rising exponentially and we need to do something to reign them in. This is a start.
From Minister Atherden: “The decision to use the USPSTF guidelines was based on the fact that international studies have found that annual screening for women with no symptoms and no risk factors leads to over-diagnosis, which results in repeated exposure to low levels of radiation and unnecessary treatment. The guidelines are highly credible and based on extensive meta-analyses of international studies.
“There is no local study to support the notion that Bermudians of African descent might benefit from earlier detection, and neither of our guest prevention experts [Dr. Welch or Dr. LeFevre], nor the physician representatives collaborating in support of adherence to USPSTF Guidelines, are aware of any study data that supports improved outcome and less harm from “over-diagnosis” in such a sub-population who are systematically screened earlier.”
I went to the USPSTF website and they say the exact opposite of what the Minister said. It takes two seconds to google stuff.
Data Synthesis:
Mammography screening reduces breast cancer mortality by 15% for women age 39–49 (relative risk [RR] 0.85; 95% credible interval [CrI], 0.75–0.96; 8 trials). Results are similar to those for women age 50–59 years (RR 0.86; 95% CrI, 0.75–0.99; 6 trials),
Conclusions:
Mammography screening reduces breast cancer mortality for women age 39–69 years
Next the PLP machine will be stating that white folks get better/sooner/correct treatment at the hospital.
To conquer one must divide.
Shalom.
@ Terry: Don’t be too surprise if you hear negative statements as the one you’d written e.g.”To conquer one must divide.” Sad yes but true
“The said amendment in the Health Insurance [Miscellaneous] Amendment Act 2015 seeks to ensure the coverage for Bermuda’s minimum health insurance package…”
So basically, if you are a person who cannot afford a better plan…too bad for you….
Clearly The Government are changing the existing policy so that women in Bermuda all start having mammograms at 50 rather than 40. This is in line with the UK and France although the UK is actually thinking of going to 47. If you have particularly dense breast s of a family history then you will be referred by your doctor to have earlier and more frequent tests.
the point that Atherden is missing is that you can develop breast cancer in your 30s and 40s without having family history and appearing to be asymptomatic. Therefore there would be no reason for the doctor to refer you. It could be missed and then you have a tragic situation.
By doing it at 40 then the chances of missing something are lessened.
The Minister has said quite clearly, “no-one is denied at anytime from having a Mammogram” It’s the Insurance Companies who feel without a doctors recommendation prior to anyone 50 yrs. old to pay for these exams themselves…(unless of course there’s a history in ones family.)
All of this political double talk. Of course no one is denied – if you can pay out of pocket then bully for you! If you don’t have those type of funds available, you are relying on your insurance to cover it. If you do not fall into the right categories (age 50+, genetic, family history, lumps, discharge etc) then you have to wait until you are 50. By then it may be too late. More and more women are being diagnosed between the ages of 35-49.
That’s why women are encouraged to do breast examinations every month.
The chance of women getting breast cancer in their 30s and 40s is much lower – it still exists but this must be balanced with the risk associated with mammograms themselves.
I for one subscribe to a wellness program which has always advocated annual mammograms for my age group as I had dense breasts. But I did my own research and determined that I was fine with bi-annual exams. Anything to avoid getting my girls squeezed
mammograms..? no one here has researched the dangers of mammograms obviously…it’s scary knowing even health care official’s are ignorant to the facts…
Mammograms cause Breast Cancer! – Dr Ben Johnson
https://www.youtube.com/watch?v=3MCKNxYCUpM
PLP trying to pull strings. ONCE AGAIN!!!
A lot said by the Minister but it all comes down to this: These recommendations HAVE NOT been accepted by the U.S. Congress. What happens if they make the decision to reject them?
Do you really believe that members of Congress are suited to making medical decisions? Wow. I’d take members of the medical profession any day over unqualified politicians.
“Any woman with an immediate family member with the disease, dense breasts or who have used hormones after menopause for five years, plus other risk factors known to the patient and her physician, will have full access to all mammography coverage necessary, as they do now.
“The decision of when to screen or not with mammography should be made by a woman and her physician, after consultation together.”
I still don’t see where it says that the cost for the mammogram will be covered for a woman who does NOT have a family history, dense breast and so on. I can only assume that a woman who does not meet any of the requirements stated above will not have coverage for a mammogram.
I do not agree with this at all and I have told my story and expressed my feelings in a letter emailed to all OBA members. From the sounds of Mrs. Atherden’s wordy explanation I am not sure it will do any good. I was diagnosed with breast cancer on the right side in 2011 and the left side in 2013 – no family history – nothing to say I would get breast cancer. Mammograms can save lives!
The explanation above is not clear and does not answer the main concerns. Who will receive coverage versus who will be denied? How many woman will this affect? How many woman who do not have comprehensive medical insurance through their employers will be unable to afford a mammogram? Will a woman be denied coverage because she is under 50, does not have a family history of breast cancer and, assuming she can tell (probably needs a mammogram), has dense breasts?
I totally agree with you as someone who’s in the high risk group. I’ve been getting mammograms since I was in my 20s and I’m not 40 yet. I had to fight with my doctor to get the referral. What happens to the women who can’t afford the tests based on their insurance plan because they’re no longer covered?
I’m pretty sure that people’s health insurance costs will not decrease with these changes. We are playing Russian roulette with people’s health!
And why has there been no comment on this from either PALS or Bda Cancer & Health? They should be very alarmed at this change in legislation!
I am well under 50. No family history, no symptoms, no dense breasts, no genetic markers. I went for my annual mammogram and they saw a small shadow which turned out to be LDIS (look it up – no time to explain). Needless to say, I did not feel a lump. It was caught by a mammogram. Let’s say this bill passed 2 years ago. Now based on my interpretation of the bill, I would not be a candidate for early screening so I would not be covered until I turned 50. By then the LDIS probably would have developed into metastasized cancer. So now my insurance will have to cover treatment concerning that, which is a lot more than removing LDIS believe me. Prevention is better than cure! Don’t turn my breasts into a political football!
Let me correct something. It is LCIS. Emotional typing earlier. Lobular Carcinoma In Situ.
Mammograms can save lives! Well said with a punctuation mark as it comes from someone whose life was more than likely saved because of the current practice of screening at the age of forty.
“Locally, physician leaders from the Bermuda Medical Doctors Association, the Bermuda Medical Council, and the Bermuda Hospitals Board, support the recommendation in addition to the Bermuda Health Council.”
Someone should tell these local medical practitioners they are wrong also and that keyboard warriors with no medical degrees know better than trained professionals.
Well at Relay for Life I will ask some questions I am sure light will be shed
I am 46 years old, I started my regular mammogram screening at 40, I have no no genetic markers and no dense breast. I went for my yearly mammography in February 2013 to be called back for more scanning to having a breast biopsy and later told I had stage 2 grade 3 Tripple Negative Breast Cancer my tumor was Invasive Ductal Carcinoma.
My tumor could not be felt it was deep in my breast. Had I not went for these regular mammograms my cancer would of have been caught late, from 2012 to 2013 cancer was developing in my breast, it was caught early. Thanks to the regular yearly screening. Waiting to get a mammogram at the age of 50 is not good, that is not early detection. I know a few women who have been diagnosed with breast cancer before the age of 40.
This new protocol is a disaster. With no history of Breast Cancer, I went to BDA Cancer and Health for my annual mammogram. A tiny lump was found. I would have never felt it. By this early detection, I was able to have a small lumpectomy, and radiation. If I had to wait another year for the mammogram, I would have had a bad sceen with my lymph nodes spreading the Cancer all over my body.
I am a lucky person to have had an annual mammogram. The proposal is just a cost cutting measure.
Making Sense of the Health Care Debate
Senate Blocks Use of New Mammogram Guidelines
December 3, 2009 12:18
The Senate on Wednesday night agreed to bar the federal government from relying on the findings of an independent panel of health experts that recently recommended women should begin having routine mammograms at age 50 rather than at age 40.
In a joint statement emailed to WebMD, the American College of Radiology (ACR) and the Society of Breast Imaging say the new guidelines could cost women’s lives.
Calling the guidelines a “cost-cutting” measure, the ACR states that “two decades of decline in breast cancer mortality could be reversed and countless American women may die needlessly from breast cancer each year.”
http://www.webmd.com/breast-cancer/features/new-mammogram-screening-guidelines-faq
if ever there was an appropriate time to march on Parliament hill, this would be the one. all people concerned about these changes need to come out wearing pink for every breast cancer victim and survivor.
what concerns me is that these recommendations are based on a wide study of thousands of people yet it seems no studies have been done on the Bermuda reality. the statistics are staggering for a country this size, we i understand, we lead the world in certain cancers and diseases.
how about we do right for Bermuda based on Bermuda’s own statistics?
It is a shame to see some people just accept what the minister has said as GOSPEL when this isssue is far from being resolved in the US. This is primarily a cost saving measure being pushed by the insurance industry and has nothing to do with best pratices. For any procedure to be considered best practice it must be globally accepted and these guidelines are NOT globally accepted. The attempt to compare Bermuda to the US is not valid due to the size difference along with other factors and we should not be doing something just because the US is doing it.