Ezra Klein: Komen’s accidental case against breast exams

Which gets to one of the weirder wrinkles in this debate: The argument, made by Komen, that mammography counts as a cancer prevention service, but clinical breast exams don’t. If Komen sticks to that position, it could be a reason for them to refuse future grant applications from Planned Parenthood. But it would be a strange reason, given that Komen’s Web site currently recommends clinical breast exams for all women over 20.

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Planned Parenthood acts as a sort of primary care doctor in this process: You go to them, and they tell you what to do next. “Planned Parenthood offers breast exams at every one of our family planning health centers,” says Tait Sye, a spokesman for Planned Parenthood. “And like the vast majority of primary care physicians and ob-gyns, we refer our patients to other facilities for mammograms when indicated based on a breast exam, age or family history. Last year, we provided nearly 750,000 breast exams.”

One argument for Planned Parenthood’s role is that many women don’t have a primary care doctor, and don’t know where they need to go for a mammogram, or even that they need to go for a mammogram. Planned Parenthood, which often has a long-standing relationship with poorer women whose attachment to the health care system is more marginal, helps set them up with whatever cancer screenings are most appropriate for them.

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If Komen had initially argued that they would no longer fund organizations that didn’t directly provide mammograms, they would, perhaps, have had an easier time explaining their decision. Of course, that might have meant defunding a much larger swath of organizations. It also would have meant changing their recommendations to women.