Women’s Health Care Takes A Massive Downward Dive With Medicare and We Women Must Advocate for No More Limitation on Coverage for Boomer Women’s Vaginal, Cervical, Uterine and Breast Cancer Diagnosis and Prevention

SurgeryThis Grandma made an annual appointment for the gynecologist.  I received a call from the office right before the appointment.  They cancelled my appointment.  Why?  Because Medicare only covers a gynecological appointment every other year.  I tried to talk to the office person about having a secondary supplemental medical policy and she said it does not matter.  I talked about getting a referral for my annual mammogram and was told that I no longer “needed” that as well.  I said I wanted it as I had had a scare some years back, and needed follow-up.  Never mind.  It didn’t matter.  Yes, I am changing doctors, but I am beginning to realize that it does not matter who I use.  Women’s health care takes a massive downward dive with Medicare as we live longer (we never say older).

Medicare Part B covers a Pap smear, pelvic exam, and breast exam only once every 24 months for all women.

Even as science confirms we Boomer women are living longer, it seems Medicare does not believe we have sex anymore or at risk for fibroids, vaginal problems, or cancer of the cervix, uterus or breast. We can only get screened every other year, not every year, unless we are at “high risk,” which is very narrowly defined.  If the doctor, when we finally can, get in for a visit that Medicare now defines as “preventative,” wants to investigate a new or existing problem, the additional care may be considered diagnostic for which Medicare will bill us!

Here is the link to the Medicare website.

Vaginal, Cervical and Uterine Cancers

I researched how valid this Medicare limitation was for us Boomer women as relates to pap smears and diagnosis to detect vaginal, cervical, and uterine cancers.  I found a study on The Cancer Network that is very disturbing.  It is from 2001, but if this information has been known since 2001 the fact of the Medicare limitation is, in my opinion, showing how little Boomer women’s health is considered.

In “Gynecologic Malignancies in Older Women,”by Ramin Mirhashemi, MDWilberto Nieves-neira, MDHervy E. Averette, MD, May 1, 2001, Modern Cancer Network, we learn

“Ovarian, endometrial, and vulvar cancers are diseases seen more commonly in postmenopausal and elderly women. Cervical cancer continues to be a significant problem in the elderly and is usually detected at a later stage in that population than in younger patients.”

Detected at a later stage!  Now I know why!  The study confirms that the pap smear is the primary tool for detection. One of the conclusions of the study is that, “[a]ge, by itself, should not alter the diagnostic and therapeutic approach to gynecologic malignancy.”

If I am waiting two years for screening at a time when I am at great risk, this Medicare policy of limitation on coverage to once every 24 months is dangerous to us Boomer women.  Read the study at this link:

Breast Cancer

Now, let’s get to mammograms.  I researched how valid this Medicare limitation was for us Boomer women as relates to breast cancer diagnosis.  We women are trained to get our mammograms annually.  It is simultaneous to our annual gynecologist appointments.  When I saw the September 14, 2018 New York Times article, “For Elderly Women With Breast Cancer, Surgery May Not Be the Best Option,” by By Paula Span, I initially thought that it was positive, especially for me in my early 70’s.  Then, when I read it, I started to hyperventilate.  Again, women’s health care takes a massive downward dive with Medicare as we live longer (we never say older).  The article talks about deaths from breast cancer for the population in 80’s and 90’s, but there are some serious takeaways for us Boomers.  Here are some quotes:

“But it takes more than 10 years after screening to prevent a single breast cancer death for 1,000 patients screened, if they’re of average risk. So researchers say mammograms (and colon cancer screening, which involves a similar time lag) are most useful for those with life expectancies greater than a decade.”

That led to a link to a 2014 study, “Screening Mammography in Older Women: A Review,” by

Louise C. Walter, MD1,2; Mara A. Schonberg, MD, in the JAMA Journal at this link:

The findings include:

“Age is the major risk factor for developing and dying from breast cancer. Breast cancer risk factors that reflect hormonal exposures in the distant past, such as age at first birth or age at menarche, are less predictive of late-life breast cancer than factors indicating recent hormonal exposures such as high bone mass or obesity. Randomized trials of the benefits of screening mammography did not include women older than 74 years. Thus it is not known if screening mammography benefits older women. Observational studies favor extending screening mammography to older women who have a life expectancy of more than 10 years.”

The researchers “searched PubMed for English-language studies in peer-reviewed journals published from January 1, 1990, to February 1, 2014, to identify risk factors for late-life breast cancer in women aged 65 years and older and to quantify the benefits and harms of screening mammography for women aged 75 years and older.”

So, they searched studies about us from a 14 year period. And what they discovered is that medical science does not study us women after age 74, it seems.  But the science shows that age is a major risk factor for us and if we have 10 years longevity we should have screening and treatment.  It seems Medicare has determined, although we Boomer women clearly have at least 10 years left in longevity, to limit access to mammograms to every other year for us!  It seems there are insufficient studies after age 74 on us women, but Medicare has determined to limit access to mammograms to every other year for us!

Here is the link to the New York Times article:

Going back to the last paragraph of the New York Times article, I read:

“The United States Preventive Services Task Force doesn’t recommend mammograms for women over 75 because there’s insufficient evidence to assess benefits and harms. Older women have largely been excluded from clinical trials.”

There is a link in that paragraph to the U.S. Preventative Services Task Force at

They conclude “that the current evidence is insufficient to assess the balance of benefits and harms of screening mammography in women aged 75 years or older.”

Where are the studies?  Where are the clinical trials? I went to my go to resource, Science Daily and put in the search space: “screening mammography for women aged 75 years and older.”

Newer Studies Favor Screenings for Women With No Cut Off in Age!

Yes, there are newer studies that show benefit to us Boomer women for screenings for prevention.   We need to advocate for removal of the 24 month limitation.

First, the statistics from a 2016 study:

“Breast cancer is the second most common cancer in women after skin cancer and occurred in 230,000 women in the United States in 2015. “

“Breast cancer afflicts 1 in 8 women in their lifetime and 1 in 25 die from this disease. “

“Although a number of randomized trials demonstrate the clear benefits of mammography screening in women up to age 74 on reducing mortality, data are sparse in women over the age of 74, especially minorities. “

In 2010, 41 percent of breast cancer deaths occurred in the more than 19 million women who are between the ages of 65 to 84 years.” (Emphasis added).

The study, “Benefits of regular mammography extend to the elderly, study suggests,” January 6, 2016,  Florida Atlantic University, at this link:

 concludes:

“Although a number of randomized trials demonstrate the clear benefits of mammography screening in women up to age 74 on reducing mortality, data are sparse in women over the age of 74, especially minorities. A new study shows that black and white women ages 75 to 84 years who had an annual mammogram had lower 10-year breast cancer mortality than corresponding women who had biennial or no/irregular mammograms.”

The second study published on Science Daily, says it all in its title,“No evidence for age-based mammography cut-off, according to large study,”November 28, 2016, Radiological Society of North America, at this link:

Now, as of November 2018, we have definitive information that we Boomer women must continue annual mammography, and the previous waivering studies are just wrong.  According to a new Radiological Society of North America (RSNA) study of a large population reported on Science Daily November 21, 2018, women age 75 years and older should continue to get screening mammograms because of the comparatively high incidence of breast cancer found in this age group.

The study shows the need for continued annual mammography.  Just read this quote from the report:

“There were 76,885 patients (10 percent) age 75 and older included in the study. The average age of the patients was 80.4. A total of 645 malignancies were diagnosed in 616 patients, for a cancer rate of 8.4 detections per 1,000 exams in this age group.

“For the relatively small percentage of our screening population that was composed of women 75 and older, the patients diagnosed in this population made up 16 percent of all patients diagnosed with screening-detected cancers,” Dr. Destounis said.

Researchers also found that 82 percent of the malignancies diagnosed were invasive cancers, of which 63 percent were grade 2 or 3, which grow and spread more quickly. Ninety-eight percent of the cancers found were able to be treated surgically. Positive lymph nodes were reported at surgical excision in 7 percent of the patients. Seventeen cancers were not surgically treated due to advanced patient age or overall degraded patient health.

“Most of the tumors found in this age group were invasive, and almost all of these patients — 98 percent — underwent surgery,”” by Dr. Destounis, M.D., radiologist at Elizabeth Wende Breast Care, LLC, in Rochester, N.Y.

We Boomer women are great in numbers and need to act!

Forward this blog post to every Boomer woman you know.  Post this on your Facebook page.  Better yet, call and write everyone you can and tell them to change the Medicare screening policies for women to gynecology appointment to once a year with pap screenings and mammograms once a year.

I HAVE MADE IT EASY FOR YOU.  JUST CLICK ON THE LINKS BELOW.

GIVE THEM THE LINK TO THIS POST AND SAY:

Please change the Medicare screening policies for women to gynecology appointment to once a year with pap screenings and mammograms once a year to prevent vaginal, cervical, uterine, and breast cancer.  

U.S. Preventative Services Task Force 

Medicare

Republican Senator Susan Collins

Democratic Senator Elizabeth Warren

Here is an article with links to all 20 women senators:

Why links to the women?

For Boomer men, Medicare and Medicaid will cover drugs like Viagra or Cialis if it is prescribed by a doctor for another reason other than sexual problems. For example, Viagra would be covered if it were prescribed for pulmonary hypertension, a heart condition that can be improved with Viagra.

For me as a Boomer woman, can a pap smear or mammogram be prescribed for prevention for pulmonary hypertension, when limitations in Medicare coverage to every two years for me to find out if I have vaginal, cervical, uterine or breast cancer are causing me to have the pulmonary hypertension?

 

Joy,

 

Mema

 

 

 

 

 

 

 

 

 

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