On mammograms: get beyond political posturing
As we blogged when we first learned of the U.S. Preventive Services Task Force's revised recommendations on frequency of mammograms , we wished USPSTF were as influential as media coverage suggested -- and not because we wanted to express an opinion on this recommendation. Rather, we wanted to endorse the process of evidence-based public health policy.
That was two or three forests worth of coverage ago, and most of the media accounts studiously avoid the real question: is there evidence to support the recommendation? Story after story deal with the outrage on the left about damage to women's empowerment or, conversely, on the right, questions about whether the reduced use of the procedure presages the rationing of medical care alleged integral to ObamaCare.
Dr. Gilbert Ross of the American Council for Science and Health has a healthier perspective.
“I don't think this issue is a gender-related one at all,” says Dr. Ross. “It certainly shouldn't be. Actually, the emerging recommendations for PSA screening for prostate cancer are very similar to these breast cancer recommendations. The authoritative bodies weighing in on PSA screening basically say don't do it unless there is some rationale for it in terms of specific risk factors, because the potential downsides outweigh the benefits. Of course, any kind of cancer screening is always an emotional issue. For women who want a more individualized risk estimate to help guide them in this decision, the NCI has a 'tool' for figuring out one's risk for breast cancer. Some women in a higher-risk category, besides getting more frequent mammograms, may also consider discussing with their doctors the potential benefits of taking a drug to reduce risk of breast cancer -- chemoprevention.
...“We believe that politicizing this issue does no one any good and contributes to confusion among women and their doctors,” says Dr. Ross. “In fact, this is an unusual instance when we agree with a New York Times editorial, calling for the mammography screening discussion to be completely severed from the ongoing healthcare reform debate.”
ACSH quotes Dr. Arthur Caplan,director of the Center for Bioethics at the University of Pennsylvania, added his weight to the argument for reason:
“In this case, the taskforce found that screening all women in their forties led to too many false positives and too much unnecessary follow-up testing for the number of lives it saved. They did not say that no lives were being saved. They said not as many as everyone thought. And not enough to justify asking every woman under fifty to get a mammogram every year...
“There is no reason to doubt the accuracy of the scientists' finding that evidence does not support routine mammography for most women under fifty. But there is every reason to doubt that the numbers they compiled will be sufficient to overturn a medical practice that carries so much ethical weight for women.”
Let's not get hung up on how we feel on this issue. Science is evolutionary. Evidence can improve over time. Let's follow the science, not the ideologues.
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