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Advice and dissent on breast exams
The uproar over a task force's new cancer screening guidelines.

Wednesday, November 18, 2009

WOMEN AGES 40 to 49 who do not have family histories of breast cancer should no longer be routinely given mammograms. Nor should all women be taught how to do breast self-exams. Those were two of the recommendations from an independent federal task force that were bound to be controversial. With breast cancer being the second-leading cause of death among women in the United States, the uproar over the change in guidelines is understandable.

Based on scientific evidence derived from an analysis of existing studies and computer modeling, the U.S. Preventive Services Task Force found that the net benefit of routine screening for women in their 40s did not outweigh the harm. Among the harms is the impact of false-positive readings, such as anxiety and the pain associated with biopsies and multiple reexaminations. Also found to not be as effective at reducing mortality was the breast self-exam. Meanwhile, the task force found mammograms for women ages 50 to 74 done every other year to be beneficial, and it strongly encouraged physicians to promote screening in this age group.

This marks a reversal of guidance issued in 2002 by the task force. Not everyone agrees with the move. The American Cancer Society looked at the same data used by the task force and concluded that the benefit of lives saved outweighed the harms caused.

The reversal of the seven-year-old guidelines, and the resulting uproar, demonstrate why reducing medical costs will be challenging even with a well-designed health-care reform bill. Ideally, medical practice should follow the evidence. When drugs or procedures are proven to do more harm than good, or to do no more good than safer or less costly alternatives, incentives should be used to discourage them. In practice, though, as new studies overtake old research and new advice contradicts previous guidelines, the result can be confusion and even cynicism -- and political pressure to ignore the results.

In this case, many experts agree with the task force's recommendations. But it's important to note that risk factors differ among women. These new guidelines are just that -- intended to guide conversations between women and their health-care providers, and to lead as much as possible to informed choices.

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