The new mammography recommendations
I don't know how much folks around here have been following the debate over the new mammography recommendations, but I've been following it fairly closely (partially because they come from the agency I work for!), and I feel the need to rant about how they've been covered in blogs (other than ScienceBlogs, of course) and in some corners of the media. I finally lost my temper while listening to NPR yesterday, in which two doctors were discussing the recommendations and this guy was completely misunderstanding the recommendations and promoting fear and a woman was politely trying to point out he was full of shit.
I'll try and dig up some good links in a second, but let me start by saying that I think the recommendations are perfectly reasonable. Perfect? Of course not. You're never going to get perfection from a committee. ::snerk:: But they're based on science, and good science at that. As the woman on NPR pointed out, the United States Preventative Services Task Force (USPSTF) is made up of scientists who are trained to analyze the data and they actually have the power to commission new studies if they think they need more data. And, in fact, they did so in this case.
So, on to what the new recommendations are: In a nutshell, they're saying that women with no family history, symptoms, etc., shouldn't get a mammogram until age 50 and then should only get one every other year thereafter. They're also recommending against routine breast self-examination (again, in women with no family history, previous symptoms, etc.) because there's no evidence for it. (Reminder: anecdotes are not evidence.)
But...and here's where the biggest misunderstanding is coming in...the task force isn't saying that nobody under 40 should get a mammorgram. They're saying that younger women should consider their options and talk to their doctor. They're saying that there's no reason for every single young woman to get one because the benefits are outweighed by the risks (such as biopsies on non-malignant tumors, essentially, too many false positives, as well as aggressive treatment for small tumors that wouldn't have grown anyway).
I've been seeing this portrayed as real-life death panels (OMG, the government is going to let 40-year-olds die of breast cancer to save money!), but it's not. The panel is arguing that screening every single woman would not save enough lives to make it worth all the other problems it would cause otherwise healthy women. You can argue with their definitions, but they're not trying to kill younger women.
I've seen it portrayed as being condescending to women (OMG, the government is saying women are such fragile flowers that they can't handle the anxiety!). No. The panel is saying that one of the risks involved in screening every woman is creating a lot of anxiety by causing so many false positives, which means somebody sticking a needle into your booby for no good reason and then you spend way too much time thinking you have cancer. (I know this because my mother has had something like three false positives. I can't tell you how unpleasant it was waiting to hear if she had breast cancer.)
I've seen it portrayed as anti-woman (OMG, the government wouldn't have done this if it was a cancer that affects men!). Untrue. See here for their report noting that there is insufficient evidence to determine if routine screening does any good in men under 75 and they specifically recommend against screening in older men, because the harm outweighs the benefits.
Orac (who's a surgeon and oncologist) analyzes the recommendations here.
Oy, I really should have been working instead of writing this, but I had to, uh, get this off my chest. (Pun intended.)
I'll try and dig up some good links in a second, but let me start by saying that I think the recommendations are perfectly reasonable. Perfect? Of course not. You're never going to get perfection from a committee. ::snerk:: But they're based on science, and good science at that. As the woman on NPR pointed out, the United States Preventative Services Task Force (USPSTF) is made up of scientists who are trained to analyze the data and they actually have the power to commission new studies if they think they need more data. And, in fact, they did so in this case.
So, on to what the new recommendations are: In a nutshell, they're saying that women with no family history, symptoms, etc., shouldn't get a mammogram until age 50 and then should only get one every other year thereafter. They're also recommending against routine breast self-examination (again, in women with no family history, previous symptoms, etc.) because there's no evidence for it. (Reminder: anecdotes are not evidence.)
But...and here's where the biggest misunderstanding is coming in...the task force isn't saying that nobody under 40 should get a mammorgram. They're saying that younger women should consider their options and talk to their doctor. They're saying that there's no reason for every single young woman to get one because the benefits are outweighed by the risks (such as biopsies on non-malignant tumors, essentially, too many false positives, as well as aggressive treatment for small tumors that wouldn't have grown anyway).
I've been seeing this portrayed as real-life death panels (OMG, the government is going to let 40-year-olds die of breast cancer to save money!), but it's not. The panel is arguing that screening every single woman would not save enough lives to make it worth all the other problems it would cause otherwise healthy women. You can argue with their definitions, but they're not trying to kill younger women.
I've seen it portrayed as being condescending to women (OMG, the government is saying women are such fragile flowers that they can't handle the anxiety!). No. The panel is saying that one of the risks involved in screening every woman is creating a lot of anxiety by causing so many false positives, which means somebody sticking a needle into your booby for no good reason and then you spend way too much time thinking you have cancer. (I know this because my mother has had something like three false positives. I can't tell you how unpleasant it was waiting to hear if she had breast cancer.)
I've seen it portrayed as anti-woman (OMG, the government wouldn't have done this if it was a cancer that affects men!). Untrue. See here for their report noting that there is insufficient evidence to determine if routine screening does any good in men under 75 and they specifically recommend against screening in older men, because the harm outweighs the benefits.
Orac (who's a surgeon and oncologist) analyzes the recommendations here.
Oy, I really should have been working instead of writing this, but I had to, uh, get this off my chest. (Pun intended.)