Let science trump politics
Published 1:33 pm Tuesday, November 23, 2010
OK, everybody take a deep breath … just as women are instructed when getting a mammogram. Relax. Repeat.
It’s difficult to have a rational discussion when the subjects are so emotional: Breasts, cancer, health care. But try we must.
Last week, the U.S. Preventive Services Task Force announced that most women don’t need a mammogram in their 40s and should get one every two years starting at 50, launching an un-nuanced uproar that lends itself well to sound bites, but not science.
The recommendations — which, contrary to some news reports, are supported by the American Cancer Society — are reasonable, responsible, and based on sound medicine.
The recommendations are not for women who have family history of breast cancer, or have any signs, symptoms or suspicions of breast cancer.
The guidelines reflect research that shows early screening, particularly for breast and prostate cancers, results in the overdiagnosis of small or slow-growing cancers that would be harmless left untreated, leading to needless surgery, emotional anguish, wasted money and resources.
On the other hand, early screening isn’t always effective in catching the aggressive breast cancers that do strike women under age 50.
According to researchers, if breast and prostate screening fulfilled their promise, cancers that once were found late, when they were often incurable, would now be found early, when they could be cured, The New York Times reported. A large increase in early cancers would be balanced by a commensurate decline in late-stage cancers. That happened with screening for colon and cervical cancers, but not with breast and prostate cancer.
Statistics show mammograms prevent one death from breast cancer for every 1,000 women who get screened over 10 years. The British Medical Journal says that means if 1,000 women don’t get mammograms, four will die of breast cancer. But if all 1,000 women do get mammograms, three will still die of breast cancer.
The concept of overdiagnosis is contrary to our “more is better” medical philosophy.
“Politically, it’s almost unacceptable. If you question overdiagnosis in breast cancer, you are against women. If you question overdiagnosis in prostate cancer, you are against men,” Dr. Peter Albertsen, chief of the urology division at the University of Connecticut Health Center, told The New York Times.
It’s also political, writes Canadian Globe and Mail columnist Margaret Wente, “because large segments of the medical industry — including radiologists, surgeons, pathologists and medical-equipment vendors — stand to lose if screening is cut back.”
It’s probably almost unacceptable to say that, too.
Is now the time to remember that heart disease or stroke kills more women than all cancers combined?
