The United States Preventive Services Task Force last Monday released new guidelines for breast cancer screening. Predictably, the Task Force’s recommendations for less vigorous screening has resulted in a chorus of dissent verging on outrage from a variety of special interest groups. The American Cancer Society says it’s not going to change its recommendations for annual breast cancer screening beginning at age 40. The society reacted so quickly that it’s hard to believe they had time to read and analyze the offending report.
The ACS’s position is not a surprise to anyone who has followed their stand on screening. They’re always for as much of it as they can find. They are prisoner’s of their component groups which often prevents them from acting dispassionately and with careful analysis. Patient advocate groups, urologists, and radiologists – just to name few – often influence the policy making of the ACS.
In assessing the advice given by a society that represents a disease constituency you must remember that it often has an axe to grind even when it’s not for profit and purportedly acts in the public interest. Furthermore, medicine is not a science, though many of its components are, and even if it were scientists are as forgetful of scientific method as anyone else when a passion grips them.
I wrote a short while ago about the paper in the JAMA which detailed the problems inherent in screening for both prostate and breast cancer. The current Task Force report is just another reminder that screening is not as simple nor innocuous as it’s often said to be.
The Task Force recommends that women who are not at increased risk for breast cancer not get screening mammograms until age 50 and that they get them every other year rather than annually. They further state that they can’t tell if screening mammography conveys a benefit at age 75 or above.
A number of commentators have construed a political message from this report. It’s release in proximity to congress’s efforts to pass a bloated healthcare “reform” bill is largely responsible for observers hostile to “reform” seeing this as the start of government mandated rationing of medical care. It really is just a risk-benefit analysis of the value of breast cancer screening. It’s very hard to get the public, and many physicians, to understand that screening has a downside as well as a benefit and that most screening tests are of unproven value or have been proven to be of no benefit.
The reports of the Task Force is below. Also below is the Canadian study on breast cancer screening published in 2002. It failed to show any benefit at all of breast cancer screening. Radiologists went mad when it appeared and has rarely been discussed since. Read both and and make up your own mind.