Dr. Kevin Most: ACA and breast cancer study
Well are we ready for President Trump? I am going to stay away from the majority of the controversy and try to single in on just one part, the ACA. Many of you heard that the House and Senate passed a bill to repeal the ACA and before we get all up in arms lets take a look at what has happened and what needs to happen.
Normally in order to repeal the ACA the Senate would need 60 votes. That is the number needed to pass most measures. Last week both the House and Senate passed a Budget Resolution which allows for the Reconciliation Process to be put in place. That Budget resolution allowing Reconciliation changes the number of votes needed to pass portions of the ACA repeal down to 51, with 52 Republican Senators it appears that a vote to repeal could pass. I believe they have until January 27th to bring forward their recommendation
The caveat here is that this is a Budget Resolution and therefore anything voted on during this Reconciliation must have an impact on the budget in order to be considered. Because of that the entire ACA cannot be repealed but parts of it may. So what could be repealed? Possibly
-Repeal of the employer mandate
-Repeal of the individual mandate
-Elimination of the subsidies for the exchanges
-End the increased Federal Funds for Medicaid expansion
-Eliminate the tax cuts for small businesses that cover workers thru the exchange
-Eliminate provider payment reductions mainly to hospitals
-And a few more portions of it
What would continue to be protected, as it would not fall under the budget resolution?
-Allowing young adults to stay on their parents coverage until age 26
-Prevent insurers from declining to cover pre-existing conditions
-Getting rid of annual and lifetime
-Block insurers from rescinding coverage for consumers once they get sick
So we should know here very soon what is going to be requested to be repealed. The next concern is that we really have not heard of what the plan is to replace , what the timing of the issues repealed would be. We know both of these concerns are not immediate, we have not seen the new plan and they could not take away care or these changes immediately. So it looks like we will have Repeal and Delay not Repeal and Replace
Another concern that was raised this week from the medical side is the possibility of President Trump asking Robert Kennedy Jr of leading a government commission on vaccine safety and integrity. The medical community is not concerned with the commission and in fact hope that it would put an end to the whole autism and vaccine concerns. However placing a prominent anti vaccine crusader in that role is very concerning. Mr Kennedy has repeatedly embraced the discredited studies that show a link between autism and vaccines. This commission may be very misleading to parents and do so much harm to the infants that are protected by these vaccines.
A recent story on CNN stated that a Danish study showed that 1/3rd of women treated with breast cancer received unnecessary treatment. This was published in a leading medical journal this week and has kicked up quite a bit of dust and controversy. Many have come out and said the Danish study is flawed and that the actual rate of over treatment is closer to 2 %. Many feel this article is not helpful at all for women’s health and may actually slow women from screening mammograms. This study was completed in Denmark as they rolled out government supported testing. They did it slowly thru the country and expected to see a large decrease in Breast Cancer that was advanced but they did not. They concluded that 1/3rd of the tumors noted would never have gone on to cause problems or further disease and thus we are treating to aggressively. They did admit that they could not tell which tumors would advance and which ones would not based on the results of the mammogram. They are now considering is there an option to monitor tumors versus treat them immediately.
Our stance has always been, tumors identified early and treated early minimizes the treatment needed and can cure.
A few quick points
1. The equipment used to detect breast tumors has improved dramatically in the past 10 years
2. This improvement is part of the problem as doctors are left with the decision to treat a tumor that has now been noted, even if very small
3. Over 250,000 new cases of Breast cancer will be diagnosed in the US this year, over 40,000 women will die from Breast cancer in the US this year
4. Tumors that were once not seen are now identified and often treated
5. We are finding that all breast cancers pose the same risk and that identifying the high risk of mortality tumors is not always easy
6. Finding a small breast tumor unfortunately cannot predict what would happen with that tumor in all women
7. Some of the over treatment that is being quoted is for unnecessary biopsies, and some is for unnecessary chemo and radiation
8. The Danish study makes some of their conclusions based on math rather than science, looking at the results of the screening program in Denmark
9. There is still some disagreement as to the age to begin and stop screening and the time between screening mammograms
10. Some experts suggest that age 40 should be the starting age, while others recommend 45 or 50
11. Some recommend annual mammograms while others recommend every other year
12. The advent of genetic screening becoming more commonplace may make the water even more cloudy