心电图的广播节目和播客, 医疗保健上升/下降, offers unfiltered perspectives on what’s working in US healthcare and what’s not. 主持:心电主任Dr. 尼克·范·特海登, each episode features guest panelists who explore the upsides and downsides of healthcare in the US—and how to make the system work for everyone.
十月是乳腺癌宣传月, and this episode of Healthcare Upside Down focuses partly on the history of breast cancer screening.
The origin of mammography—the specialized X-ray imaging of breast tissue using a low dose of radiation—is interesting. The concept originated with German surgeon Albert Salomon, 谁想象3,在1913年做了1000例乳房切除手术, but the true clinical use of the technique didn’t occur until after a 1966 study was published by American radiologist and mammography pioneer, Dr. 菲利普Strax, demonstrating that early detection significantly reduced the breast cancer mortality rate. He was spurred into a single-minded battle against breast cancer in 1947 when his first wife died of the disease.
But making the screening available to the widest number of people possible took much longer. It was not until legislation was changed and screening became a covered offering for the general public that uptake of mammography started to increase. 目前, around 70% of women over the age of 40 are getting mammograms, but racial and economic divides continue to negatively impact outcomes for a group already suffering a larger burden of this disease.
Don Lavanty is a principal at the Federal Group and a professor at Marymount University. 在20世纪80年代, he helped the American College of Radiology lobby Congress for expanded coverage of breast cancer screening. 杰西卡Turgon is a partner with 心电图 Management Consultants and the leader of the firm’s Oncology 云顶集团 practice. 《官方网站》第47集, they talk about the progress that’s been made in the early detection of breast cancer and how we can overcome the barriers to screening for the second-leading cause of cancer death in women. 下面是一些节选.
乳房x光检查的普及.
唐Lavanty: “The American College of Radiology came up with an accreditation program, 并与美国癌症协会合作, they took the lead on doing more for breast screening. It wasn’t until the late 1980s that you started getting screening programs [covered under Medicare]. 你总是在疾病发生后才付钱. It was totally different for Medicare to pay upfront before a condition had occurred. So they commissioned me to go to the Congress. 我们与参议员布洛克·亚当斯合作, 乳腺癌联盟, 科曼基金会, 还有参议员(芭芭拉·安)米库尔斯基, 谁是女性健康的真正倡导者, 使一个合格的过程到位.”
杰西卡Turgon: “我真的很喜欢唐的故事, because it wasn’t that long ago that we didn’t have access to mammography. My generation takes for granted that it will be there and will be covered by our insurance. 随着项目的扩大, people were able to catch cancer earlier in the diagnosis and get treated, 然后继续他们的生活. The impact on women living through a cancer diagnosis has been significant. 当然, 这在很大程度上取决于你住在哪里, 你拥有什么样的资源啊, and all the socioeconomic challenges that go along with current healthcare in our environment. But getting [mammography] covered was significant for cancer care in the US.”
Cost, fragmentation, and politics limit access.
唐Lavanty: “The American healthcare system was $45 billion in 1965. 现在是数万亿, 你在尝试扩展云顶集团, and you have a budget restoration process in the Congress where the tax dollars are not sufficient. 国会必须决定美元的去向. 是乳腺癌吗?? 儿童脑外科? 这是一件非常困难的事情. And the United States will never solve that problem, in my opinion. As long as we have this two-party system, we have to find a way to make both of them work together.”
杰西卡Turgon: 作为一名消费者, 你在努力做出最好的选择, and you’re listening to your healthcare provider, who’s trying to navigate you through a complex system. But maybe that healthcare provider doesn’t have all the information. As a woman who’s had to navigate care, from a personal level, it’s challenging. 唐的观点, it’s a significantly fragmented system that often is not engineered toward what’s best for the patient.”
Can new technology help improve access to screening?
杰西卡Turgon: “Until we change how a mammogram is delivered, we are beholden to the technology. 我们可以加快接入点的速度, think through various ways to engage with patients to facilitate reminders, make sure the right type of connections are made between a woman’s care provider and the radiologist, 等. But until we change how the care is delivered, 你总得去个地方, 这通常意味着要请假, 大白天就走, 有照顾孩子的问题, 诸如此类.”
唐Lavanty: “I would hope that the technology could get to the point that you could have equipment that goes into a facility. It would be amazing if you could go to a facility like you do for blood testing. 我(在药房)打流感疫苗. 我们能把它提升到那个层次吗? The unfortunate problem is there’s not a lot of money in mammography, 如果我是药品制造商, I’m not going to put my money there because there’s more in CT, 核磁共振成像, 核医学. 所以,我们还有很长的路要走.”
在播客上, Don and Jessica talk further about making screenings more affordable and accessible—and the need for women’s voices in the healthcare decision-making process.
编辑: 马特杂粮面包
出版于2022年10月17日
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