Modernization can at times be very expensive and misdirected

by admin on 06/19/2011 1:52 PM

In the 1980s, Dr. Eugene Robin, a Research Pulmonologist at Stanford, had a weekly column in the San Francisco Examiner. Having had a very distinguished career writing research papers, books, editing journals, chairing international symposia, he thought he’d try his hand in the popular press. In this column, he explored numerous areas of medicine for the lay public. He eventually had a column on the Risks of Mammography. He cited that doing regular mammograms in young women could actually increase the risks of breast cancer. He never had another column. We all just assumed that it was not politically advantageous for the Examiner to continue in an arena in which they couldn’t control such content. The uninformed public would not be able to accept such content “which every American ‘knew’ could not be true.” Everyone knew that a screening test for a disease just could not cause the disease they were screening for. The News media knew that public opinion was more valid than the professor’s opinion – even if based on scientific evidence.

Now after 30 years, this discussion is once again open to debate. Freedom of speech can only be suppressed for so long. We return to –The Mammography Debate

Mammography for breast cancer screening

Most major health organizations have concluded that mammography saves lives. However, there is ongoing debate over:

  • How much benefit there is from mammography (especially in younger women)
  • The over-diagnosis and over-treatment of breast cancer

The benefit of mammography for women ages 40 to 49

Mammography in women 40 to 49 saves lives, but the benefit is less than for older women.

Some health organizations have concluded that the modest survival benefits of mammography in women in their 40s outweigh the risks of false positive results. The National Comprehensive Cancer Network recommends routine mammography for women starting at age 40 and the American Cancer Society recommends starting at age 45 [15,105].

The U.S. Preventive Services Task Force meta-analysis of eight randomized controlled trials found that mammography modestly reduced the risk of breast cancer mortality (death) in women 40 to 49 [13]. This study found that to prevent one breast cancer death, 1,904 women 40 to 49 would need to be screened with mammography [13].

Weighing the benefits and risks, the Task Force does not recommend routine mammography for all women in their 40s [13].

Instead, the Task Force, as well as the American College of Physicians, recommends that women 40 to 49 discuss the benefits and risks of mammography screening with their health care providers. Then together, they should make informed decisions about when to start mammography screening [13,18,105]. The American Cancer Society recommends informed decision-making for women ages 40 to 44 [105].

Informed decisions are guided by a woman’s breast cancer risk profile. Women at higher risk of breast cancer are more likely to benefit from mammography [18,105]. Decisions should also be guided by a woman’s preferences based on the potential pros and cons of mammography [18].

The U.S. Preventive Services Task Force recommends that routine mammography screening begin at age 50 [13].

To be continued in July 2014 HPUSA . . .

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