The new breast cancer screening guidelines announced November 16th by the U.S Preventive Services Task Force have sparked widespread anger and confusion. The debate centers on the relative risks and benefits of various methods of trying to pick up breast cancer at an early stage. All current techniques, including mammography, MRI, ultrasound, and breast exam, can reveal abnormalities that end up being benign. These so-called “false positives” often lead to expensive, anxiety-producing, and invasive testing such as biopsy and fine-needle aspiration. The big question is: What screening tests are “worth it” and how do we define “worth it?” Read more »
I was having an interesting Twitter chat with online friends (Liz Cohen @elizcohencnn, Dr. Chuk Onyeije @chukwumaonyeije; Dr. David Gorski @gorskon; Dr. Marya Zilberberg @murzee; Sherry Reynolds @cascadia; and @speakhealth) about the mammogram debate. They asked me “where I drew the line” on paying for expensive screening tests that may save lives but require unnecessary surgery for countless others. My opinion takes into account human nature and political savvy rather than pure science and statistics on this one.
To me, the bottom line is that the mammogram is a sloppy screening test. It’s expensive, there are lots of false positives and unnecessary surgeries, yet it saves occasional lives (which is dramatic and meaningful). We have to appreciate that women have come to accept the risks/benefits of this test, and have been told for a long time that they should begin screening at age 40.
It’s not emotionally or politically possible to reverse course on this recommendation until a better choice is available. You can trade the mammogram for a better test, but you can’t trade it for doing nothing. The amount of drama associated with the perception of having something potentially life-saving taken away is just not worth the cost savings. It may be a reasonable value judgment based on the data, but it’s not politically feasible so we should mentally take it off the table. Read more »
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