THE TREATMENT JANUARY 7, 2010
Everybody noticed (and many screamed) in November when the U.S. Preventative Services Task Force recommended that women under 50 no longer get mammograms unless they were high-risk. But almost nobody noticed when, a few weeks later, the Task Force tried to clarify the recommendation's meaning.
Margaret Polaneczky, a New York physician who writes the "The Blog That Ate Manhattan," was among the few who paid attention. And she has written what is, I think, the clearest summary and interpretation of the issue I've read yet:
What the Task Force is saying is simply this - On a population basis, the net gain from adding 10 years of mammography in all women is small in relation to the risks of over-diagnosis, over treatment, unnecessary biopsies and anxiety. But you, as a patient, in consult with your physician and assessing your own personal risks of breast cancer, may decide you want to get a mammogram anyway.
What they meant to do was to take mammography out of the realm of the knee-jerk, automatic and into the realm of informed decision making. They meant to inform women that mammography's 15% or so reduction in mortality comes at a price--a price that is physical, emotional and financial, in the form of false positive results, unnecessary biopsies and the anxiety and dollar cost that accompanies them. They also meant to dispel popular overblown notions about what mammograms actually do by clarifying both their benefits and their risks, so that women are making the most informed decision they can about whether or not to have this potentially lifesaving test.
Unfortunately, they blew their 15 minutes. Which leaves it to the rest of us to clean up the mess.
She spends the rest of the item doing just that. Along the way, she sketches out an extremely level-headed to approach decisions about medical treatment in the future, both as individuals and as a society.
It's well worth a read if you have the chance. Thanks to fellow medical blogger KevinMD for highlighting this.