Suzi Wizowaty

This is not the first time an expert panel has generated recommendations that contradict earlier recommendations. Medicine is as much an art as a science--if not more--and new information should spark a re-evaluation of current practice.

NYT health writer Gina Kolata wrote a useful, brief history (Nov. 21) of medicine's conflicted relationship with mammograms. One example:

"1979 A National Institutes of Health [NIH] conference recommends annual screening for women 50 and older.

"...1997 [NIH] concludes that there is not enough evidence to recommend routine screening for women in their 40s. But the Senate votes to encourage an institute advisory board to reject that conclusion, and the institute recommends beginning mammography in the 40s and continuing every one to two years." [Italics mine.]

The U.S. Senate? What's going on here? Whenever a political body gets involved, it's worth pausing to ask who stands to gain and lose by a particular decision.

To continue:
"...2002 After reviewing the research, an independent panel at the National Cancer Institute decides it can no longer make a recommendation on whether women should be screened....

"2007 Guidelines issued by the American College of Physicians acknowledge that regular mammograms for women in their 40s can reduce the risk of dying from breast cancer by a modest amount. But a very high percentage will get false positive results that lead to unnecessary biopsies, increased costs and risks of injury. The college recommends that women in their 40s and their doctors periodically evaluate their risk to guide screening decisions.

"...November 2009 New guidelines published in The Annals of Internal Medicine recommend that most women start regular breast cancer screening at age 50, not 40, and that women age 50 to 74 should have mammograms less frequently — every two years, rather than every year."

In other words, this last recommendation is not new. It has been taken up by the Right as an example of how government will restrict access to health care, which is unfortunate but not surprising given the loose playing with facts that characterizes right-wing talk radio, for example. More worrisome is the reaction of many physicians and hospitals, immediately rejecting the recommendations.

Whatever happened to thoughtful consideration of new data? Is health care so politicized that we're afraid to take a deep breath and say, wait, maybe we've pushed too hard on this one?

Maybe public policy needs to focus on individual choice, and on the conversation between a woman and her physician. Every test has risks and benefits, and until recently physicians have been less forthcoming about the risks than the benefits. According to a NYT editorial (11/20/09), the National Breast Cancer Coalition--a patient advocacy group--has long maintained that the benefits of mammography have been oversold and its risks underplayed. We need to know the risks in order to make informed decisions.

This latest analysis by the U.S. Preventive Services Task Force (created 25 years ago), which has caused such an uproar, determined that every-other-year screening for those of us between 50 and 74 provides 80% of the beneifts and 50% of the risks of annual screening. That's useful information.

My own physician, both well-informed and cautious, supported me years ago in deciding on a mammogram every 18 months. Every woman should have such a thoughtful doc to talk to.