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Following the mammogram money

In an article in Tuesday’s Wall Street Journal, reporter Alicia Mundy describes how lobbyists for three powerful interest groups — radiologists, companies who make mammography equipment, and certain breast-cancer-awareness groups (who receive financi

In an article in Tuesday’s Wall Street Journal, reporter Alicia Mundy describes how lobbyists for three powerful interest groups — radiologists, companies who make mammography equipment, and certain breast-cancer-awareness groups (who receive financial support from those same equipment manufacturers) — have successfully pressured Congress to ensure that the final health-care bill includes (indeed, encourages) mammogram coverage for women starting at age 40.

So much for evidence-based science. As you may recall, last November, after sorting through all the latest research on preventive mammography, the U.S. Preventive Services Task Force (USPSTF) issued its explosive (in terms of public reaction) but really quite mild guidelines that routine mammograms were unnecessary for most women under 50 and that most women between the ages of 50 and 74 needed one only every other year.

Those recommendations, by the way, are the same ones Canada, which has essentially the same breast cancer survival rates as the U.S., has been following for years.

Who’s doing the lobbying against the USPSTF guidelines? Leading the charge, reports Mundy, “is the Access to Medical Imaging Coalition, whose members include [General Electric Co.’s GE Healthcare] and Siemens [AG] and several nonprofit patient groups, the college of radiology and leading doctors societies. The coalition’s director, Tim Trysla, is a lobbyist at a Washington law firm. He has been working in Congress against proposals to cut billions of dollars in Medicare spending in the health-overhaul bill that could hurt imaging-device makers.”

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Preying on fears
Much of the lobbying effort seems to involve stoking women’s fears.

Here’s the rather fear-mongering statement quoted in the WSJ from the American College of Radiology, a trade group: If the USPSTF guidelines are adopted, the group said, “two decades of decline in breast-cancer mortality could be reversed and countless American women may die needlessly.”

As with most of the fear-mongering that goes on in the health field, it’s important to follow the money.

According to the College of Radiology’s 2007-08 annual report, the organization’s research program, which examines the role of radiology in medicine, has received donations of at least $1 million each from GE and Siemens. “Both companies make mammography equipment and MRI scanners,” reports Mundy. “Several other medical-device makers donated at least $100,000.”

And, of course, radiologists themselves stand to lose money if the USPSTF’s recommendations are followed and women are encouraged (not compelled) to have fewer mammograms.

Say it ain’t so
One of the more discouraging aspects of the WSJ report is how the country’s largest breast-cancer-awareness group, Susan G. Komen for the Cure, seems unaware of how closely it’s become tied to corporations with a vested interest in promoting preventive mammography screening. Writes Mundy:

Susan G. Komen for the Cure … has worked with GE and other companies. Komen turned to GE in October when it lit the Great Pyramids pink to mark a major screening initiative in Egypt. Neither GE nor the Komen group would say how much the event cost.
In 2007, GE sold limited-edition pink cameras to Home Shopping Network, which donated a portion of the sales to Komen. Imaging and film companies whose products go into mammography equipment have made pink DVD players, pink computer flash drives and pink cellphones, a portion of whose sales raise money for Komen and other breast-cancer groups.
In events at the Capitol, Komen for the Cure founder Nancy Brinker has praised GE’s digital mammography technology, and she received a public-service award from the company.

Komen for the Cure’s support of digital mammography and of annual breast screening for women under age 50 is important for GE. The USPSTF concluded that there’s currently insufficient evidence to determine whether digital mammography is any more accurate than standard film mammography at detecting tumors in most women. Digital mammography is, however, more expensive. In addition, digital mammography doesn’t appear to present any advantage for women over the age of 50. That finding is certainly a huge incentive for those who make digital mammography equipment to keep encouraging younger women to have annual mammograms.

As Adriane Fugh-Berman, MD, a professor at Georgetown University’s medical school in Washington, D.C., (and long-time women’s health activist who believes the evidence supports less-frequent mammograms), told the WSJ:

“[B]reast-cancer advocacy has become a big business.”