Up until recently, women have been advised to start getting mammograms at age 40 and to also engage in regular self-examination. However, the U.S. Preventive Services Task Force recently decided that women under 50 should no longer receive routine screenings.
While the Task Force presented a fairly clear statement, there seems to be some confusion about this matter. This is due, in part, to the fact that other experts have been rather critical of the new guidelines.
Some might also suspect that folks in the media have contributed to this confusion, perhaps knowing that such controversy is a way to gain a larger audience.
In any case, it seems important to sort things out a bit.
First, the Task Force did recommend that women 40-49 should no longer get mammograms as a matter of routine. However, this does not mean that women in that age range should not get mammograms-rather, they should consult their doctors and assess the risks and benefits of being screened.
Second, the reason for this change seems to be based on new utilitarian considerations about existing data rather than significant new findings (although some might dispute this). As such, much of the dispute is not about the effectiveness of mammograms but whether or not the benefits outweigh the risks.
It is generally agreed that about 15% of women aged 40-49 have breast cancer detected via mammography. The Task Force members are aware of this, but note that the harms outweigh the benefits of making screening routine. One harm is that such routine testing generates a significant number of false positives thus leading to anxiety and unnecessary medical procedures, such as biopsies. Another harm is that the testing is not itself risk free, due to the fact that it generates radiation that is, ironically, capable of causing cancer. There is, of course, also the matter of cost of such tests.
Others, such as Dr. Otis Brawley of the American Cancer Society, use basically the same factual data but come to a different conclusion. Dr. Brawley asserts that “with its new recommendations, the [task force] is essentially telling women that mammography at age 40 to 49 saves lives; just not enough of them.” Not surprisingly, the American Cancer Society is sticking with the previous guidelines. The reason is, obviously enough, based on their assessment of the costs and benefits based on their values. On their view, the benefits of routine screenings outweigh the harms and hence they support this practice.
Thus, the dispute is not primarily one of fact but of value. The Task Force and its critics generally agree on the facts, but they disagree in their assessment in regards to whether such routine testing is worthwhile in terms of their weighing of the risks and benefits.
Since non-experts turn to experts for answers, the fact that the experts disagree means that the rest of us are somewhat at a loss when deciding what to do. After all, if the experts disagree, then a non-expert has little basis on which to decide which expert is most likely to be right.
In this situation, the facts seems to be that mammograms can be effective in detecting breast cancer in women under 50, but that there are legitimate concerns about the possible risks. As such, the best advice seems to be what both sides suggest: consult your doctor in this matter and hope that s/he is able to provide an effective and reasonable recommendation.
One last matter worth considering is what effect this will have on insurance coverage for mammograms. Since insurance companies use the Task Force’s guidelines there is some concern that mammograms for women under 50 might no longer be covered. After all, the insurance companies can point to these guidelines when denying coverage-thus having an easy and seemingly reasonable way out of paying.
Those inclined to being suspicious might wonder about the timing of this change. After all, the insurance companies have been involved in all the deal making about health care reform and one might suspect that such a change in guidelines might be connected to politics. Then again, it might just be a matter of coincidence.
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