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Rising maternal deaths in Texas, breast cancer over-diagnosis, and RCAW events for women’s health

October 13, 2016

In order to bring you more of the news you want to read, RightCare Weekly summarizes and interprets three important articles and provides headlines linking to the many other articles and editorials you’ll find interesting. As always, RightCare Weekly presents articles related to moving our healthcare system toward the right care for all patients.

This week we’re focusing on women’s health issues, in recognition of Breast Cancer Awareness Month.

Join the conversation: Post your comments in our new section at the bottom of this page.

The number of pregnant women and new mothers who died in Texas doubled between 2010 and 2012, according to a recent study in Obstetrics and Gynecology. While maternal deaths nationwide have been slowly increasing since 2000, the recent drastic rise in the maternal mortality rate in Texas has researchers and policymakers baffled. The Texas Department of Health has not released much of the data surrounding these deaths, precluding a definitive explanation, but preliminary research from a state task force suggests that lack of access to care is largely to blame. Texas is one of 19 states that did not adopt Medicaid expansion, leaving more low-income women without needed care. “In Texas we have the largest percent of uninsured patients in the U.S.,” said Robert Gundy, MD, of the Baylor University Medical Center, in a Dallas News article this week, “and it’s these patients who wait until late pregnancy or until an emergency develops to seek care.” Additionally, Texas slashed its family planning budget by two-thirds in 2011, reducing funding for prenatal care clinics used by low-income women. This reduction of accessible care has had a disproportionate effect on African-American women, who represent one tenth of the births but almost a third of the state’s maternal deaths. The rate of maternal death in Texas is unique but, unfortunately, unequal access to women’s health care is widespread.

Writing a companion editorial this week in the New England Journal of Medicine, Joann Elmore, MD, MPH, states that over-diagnosis of breast cancer has become more prevalent since mammography was introduced in the U.S. She cites research conducted by H. Gilbert Welch, MD, et al, appearing in the current issue, which indicates a shift in size distribution of breast cancer tumors from the 1970s to the early 2000s. That study found large tumors decreased by 30 cases per 100,000 women, and small tumors increased by 162 cases per 100,000 women, suggesting extensive over-diagnosis of small tumors—tumors that were unlikely to cause symptoms or death. Elmore advocates for precision screening for those with increased risk, rather than screening large populations of women at low risk. She also calls for better tools to evaluate data and diagnosing individual cases. “We are using archaic disease-classification systems with inadequate vetting … Diagnostic thresholds for ‘abnormality’ need to be revised because the middle and lower boundaries of these classification systems have expanded without a clear benefit to patient,” she writes. Improved communications about over-diagnosis is needed at all levels, from research that’s conducted to patient education, she writes. She urges physicians and researchers to “take ownership of . . . the screening cascade, including the collateral damage of our well-intentioned efforts.”

Too often women undergo hysterectomies, ureterectomies and C-sections without knowing about less invasive alternatives. That’s why the Women’s Health Council of the Right Care Alliance, chaired by Katherine ‘Trina’ Hikel, MD, and Kim DiGioia, MSPH, is eager to find out about the care some women are receiving by asking them during Right Care Action Week, starting on Sunday. Hikel says that patients can sometimes feel pressured to consent to tests and treatments even when the risks and harms associated with them are not discussed, or when there is no scientific evidence backing those tests and treatments. “Too many women have been treated drastically for medical conditions that are benign,” she emphasizes. Members of the council will be handing out ‘what’s your biggest worry’ index cards to patients of midwives and doulas, as well as to mothers at daycare centers and mom-and-baby support groups. They hope to learn where there may be gaps in care from the written responses they collect. It’s not too late to sign up for Right Care Action Week. Do so here.

Announcement

Reminder: For the Lown Institute 5th Annual Conference, May 5-7, 2017, in Boston, we continue calling for abstracts for our special academic research symposium on Friday, May 5. We’ll highlight research that enhances our understanding of right care. On Saturday, May 6, we will be holding skills-building workshops. We welcome and encourage your proposals for workshops that will engage all health professionals, patients, patient advocates, and community leaders. Deadline for both submissions is December 18. Learn more about abstracts here. Learn more about workshops here.

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RightCare Weekly is made possible through the generous support of the Robert Wood Johnson Foundation.