Mammogram Recommendations Could Reverse Years of Progress

Reader Comments
Back to blog

I question the conclusions of groups like USPSTF. There is a whole series of events intervening between screening, biopsy, detection of possible cancer, sometimes early stage, decision making in collaboration with physicians, possible treatment, outcome. Missteps in any one of the stages can lead to an undesirable outcome EVEN IF screening provides a key starting point (which all of the experts believe --- no matter what the statisticians conclude). So why are the statisticians wrong? Because they ignore the path. For example, a report has just come out , showing that the majority of prostatetectomies in this country are performed by surgeons with extremely limited experience resulting in a substantial reduction in effectiveness and increase in negative side effects. But wait you say, what does that have to do with PSA screening. Simple --- many of the men getting inferior treatment had their initial diagnosis via psa screening. So a study by USPSTF which just looked at PSA and at final outcome would "conclude" that the PSA screening didn't work, when what really didn't work was a further step the surgery because of the incompetence of the surgeons. USPSTF needs to look at these sorts of factors before coming up with much in the way of useful conclusions in my scientific opinion, or else all they should conclude is that you don't have good followup available don't get mammograms and PSA tests. More importantly --- we need advice on how to get qualified practitioners, not on avoiding obtaining potentially useful knowledge about whether or not we have early stage cancer. From the report:
www.medscape.com/viewarticle/713012?sssdmh=dm1.560691&src=nldne&uac=121910CN November 25, 2009 — The majority of surgeons performing radical prostatectomy in the United States have extremely low annual caseloads, which can result in an increased risk for surgical complications and cancer recurrence, according to a new analysis published in the December issue of the Journal of Urology.

Lee Smith of NY 7:37PM November 28, 2009

While the US Preventive Services Task Force recommendations for breast cancer screening for the 40-49 y.o. age group of women did NOT change since 2002, the uproar in the press continues. This brings to light the conflicting recommendations as to what constitutes the standard of care in medicine today. The issue is that there are different standards for the same disease across specialties and across the first world. Ironically, the USPSTF is recognized as “the standard” worldwide for making prevention guidelines because of the extensive review of medical research that goes into the process to determine public health guidelines for the general population. The American Cancer Society and other groups are looking at the sub-segment of the population diagnosed with cancer, not the proportion of those people relative to the entire population. Interestingly, no one has mentioned that these groups may have their own political, legal or monetary concerns. If it costs more to screen people to find one case of disease than it does to treat one case of disease (at the average stage it would be found), there is no point in screening. It costs more than it’s worth. [Obviously the individual who may have cancer doesn’t feel that way. But from a societal standpoint, where money is not an unlimited commodity, we must seek the biggest bang for our healthcare buck.] In this case, a better screening test that does not yield a cumulative 43% false-positive rate by the ninth mammogram or a cheaper one to make it worthwhile for this age group.
More info at aocopm.blogspot.com

Dr. Debra A. Smith of IN 5:20PM November 23, 2009

Let everyone be forewarned, this is what we have to look forward to with Obama care, Pelosi care and Reid care. This isn't reform, it's the outright destruction of our health care system.
Anyone who can't see the writing on the wall is either blind or ignorant.
Our country is being destroyed by the likes of this government panel who was appointed by the politicians we have put in office.

Left Coast Geno of CA 3:58PM November 20, 2009

I am a conservative and I want nothing to do with a Nationalized Health Care system. I simply think the evidence does not support yearly mammograms. I would however order mammograms in high risk patients. In fact I order them in all women simply to avoid becoming the object of a law suit.
If we have a Nationalized Health Care system there will be no discussions with you physician, no individualized care. Care will be delivered in a rigid fashion based on guidelines that favor political constituencies.
Whatever system we have there is no excuse for doing things that offer no benefit and potentially cause harm.
Check out the following link which is the results of a large 40000 women study showing no reduced mortality from mammograms (and there are others): http://www.cmaj.ca/cgi/content/abstract/147/10/1477

Toffler of SC 12:31PM November 20, 2009

You want to be healthy? Then do not smoke. Eat healthy foods. Exercise. Get your blood pressure checked yearly, get your PAP smears and go to the doctor when your are sick, not when you are well.
LOL! You can change "get your PAP smears" to "get your PAP smears every three years or so."
Welcome to rationing. We're moving to a Canadianesque system. The fix is in. We have to get the guidelines changed before we switch so that the government can say that switching had no effect on our health care guidelines.

Little Old Me of FL 9:38AM November 20, 2009

I don’t understand why the USPSTF approach is called “evidence based”. Pardon my ignorance but it seems to be after the fact statisical correlation studies, not controlled scientific studies. I would hypothesize that these massive average studies bring home the point that on average medical advice probably isn’t very good, so each individuals goal should be to find the best Dr’s they can, get multiple opinions, avoid panic, but always SEEK KNOWLEDGE that screening clearly provides in many many cases. If you are willing to go to a USPSTF member for medical advice then take their recommendations, but DON”T expect any individualized approach. On the other hand if you go to an expert in the field, someone with lots of experience in the disease you are facing, you are, in my humble layman’s naive approach bound to get a better outcome than the USPSTF can provide you with. According ot USPSTF medical approaches are like going to the Casino, and you cannot beat the odds. However, I believe if you go to a knowledgable practitioner you can fix the odds in your favor and increase the chances of winning — i.e. avoiding metasticizing cancer that screening has revealed. I know because it happened to me and other family members whom the USPSTF approach would have doomed to fighting cancer for the rest of our lives. USPSTF has a right to their religion of mass statistics but they shouldn't disguise it as good medical practice.

Lee Smith of NY 11:56PM November 19, 2009

This person Claims it is a guess on the number of lives it saves then using your logic that make the whole recomendation a guess.
This person doesn't correctly value the life of a 40 year old mother of young kids. The test saves 1 life for 1904 test performed for women in their 40s.
-----------------------
There have been 2 large studies, one from Canada with over 40,000 women which found no benefit to mammograms. If there is a benefit, it so small it is difficult to measure. The one in approx. 1900 women screened to save 1 life is a guess. The recommendation to not perform the mammograms should have been made a long time ago.

joe of PA 9:55PM November 19, 2009

There have been 2 large studies, one from Canada with over 40,000 women which found no benefit to mammograms. If there is a benefit, it so small it is difficult to measure. The one in approx. 1900 women screened to save 1 life is a guess. The recommendation to not perform the mammograms should have been made a long time ago.
As for PSA screens, the USPSTF already make no recommendation for screening men under age 75 years and says not to screen men over 75 years. Why? Because there is no clear benefit. I have no intention of getting my PSA checked and I am a physician.
Other wasteful things we do are:
Primary prevention of coronary artery disease with statins.
Coronary stents and CABG rather then medical therapy.
Antidepressants for situational depression.
Advising moderately overweight people to lose weight.
Research these things yourself and see just how slim the benefit is.
You want to be healthy? Then do not smoke. Eat healthy foods. Exercise. Get your blood pressure checked yearly, get your PAP smears and go to the doctor when your are sick, not when you are well.

Toffler of SC 2:34PM November 19, 2009

MediaCurves.com conducted a study among 600 about the new guidelines released by the Preventive Services Task Force of the Department of Health and Human Services recommending against regular mammography tests for women under 50 years old. Results found that the majority of physicians (78%) reported that they do not agree with the new guidelines. Furthermore, the majority of physicians (78%) also reported that the advice they give to patients will not change based on the new Preventive Services Task Force of the Department of Health and Human Services guidelines.
More in depth results can be seen at:
https://www.mediacurves.com/HealthCare/J7646-MammogramGuidelines/Index.cfm
Thanks,
Ben

Ben of NJ 1:58PM November 19, 2009

the first storm cloud of the "Public Option" on the horizon. The dead bodies will come later.
I think the Obamatrons should have waited until they got their "healthcare" deal passed before they dropped this little hint of things to come.

R.L. Schaefer of CA 1:49PM November 19, 2009