USPSTF Breast Cancer Screening Recommendations

By John Ballard

The U.S. Preventative Services Task Force kicked over a hornet's nest this week by changing the long-standing recommendation for routine mammogram screenings for breast cancer in women. I cannot imagine any reader who missed the story, but in case anyone just recovered from a coma here is a thumbnail version. 

The new recommendation from the U.S. Preventative Services Task Force that women under 50 should not undergo routine mammography is generating a lot of controversy—it is a direct challenge to the strong message women have been receiving for two decades that they should have yearly screening starting at age 40. The task force also recommends that women age 50-74 have a mammogram every two years (rather than yearly) and finds that there is little benefit in screening women over 74 at all.

As a guy (this is a women's issue), I'm steering clear of the story except for this brief mention. As is the case for most medical questions, this is a matter best left to individuals, their families and their doctors. Unfortunately, the health care debate is causing a great many people to simplify complex issues, making one-size-fits-all judgments regarding questions that will never be normative for all.

Naomi Freundlich's summary (above link) is excellent. And this comment left at another post sums up my feelings exactly.

The flap over the USPSTF breast cancer screening guidelines is a sad microcosm of the health reform debate and the near impossibility of reducing costs. An independent expert panel, using the latest available data, makes recommendations that vary somewhat from the conventional wisdom. Immediately, the guidelines are excoriated by providers, interest groups, and patients. Opponents of health reform and comparative effectiveness research start in with "I told you so." HHS backpedals furiously, reassuring everybody that Medicare coverage policy won't change.

The logical extension of all these objections, of course, is to test everybody for everything. Women in their 30s get breast cancer, maybe they should be tested. How about women in their 20s? Why not men? We're not immune from breast cancer.

Emotion almost always trumps science in politics. And if my wife was one of those who was diagnosed with a mammogram at age 45, I'd probably be emotional too. We don't like to draw lines.

But until we can have an intellectually honest, dispassionate discussion of the costs/benefits of health care practices and procedures, how can we ever hope to "bend the curve?"

The operative word here is recommendations.
What's not to understand?
The details which led these recommendations are neither secret nor mysterious.
Unfortunately for many they happen to be scientific, having to do more with numbers than emotions.

Comments

[Michael Kirsch, M.D]

Bad move by Sebelius. She caved to politics and trashed science and evidence-based medicine. The USPSTF, under her own HHS agency, made sober recommendations. Now, they're under the bus. Is this the kind of comparative effectiveness research that Obama has in mind? See http://bit.ly/656CwP

[John Ballard]

Thanks for your visit and comment. I have added your site to my aggregator.

A look at the comments thread at Naomi's article (linked first above) is a study in frustration on the part of those who know the recommendations were made for neither political nor monitory reasons. They are essentially in accordance with guidelines for the rest of the modern world.

I haven't decided if the administration's back-peddling was the result of cowardice or political gaming at a fragile moment in reform legislation. Righteous indignation is easy for the losing side of an issue but fragile majorities must be more circumspect. What we have witnessed may be the political equivalent of "collateral damage" or "friendly fire" on the way to a larger goal.