HER2 Support Group Forums - View Single Post - New Proposed Changes to Mammogram Guidelines

gdpawel · 01-13-2010, 11:33 AM

The storm that greeted the USPSTF guidelines on mammography screening for women in their 40s prompted the Senate to insert a mandate in its health care reform bill that every insurer cover every mammography screening test at no cost to beneficiaries.

The Journal of the American Medical Association (JAMA) published an article, "The Benefits and Harms of Mammography Screening: Understanding the Trade-offs," reminding physicians and women about the serious health costs of adopting that policy.

The authors, Dartmouth's Steven Woloshin and Lisa Schwartz, used the "number needed to treat" analysis to point out:

Without screening, 3.5 of 1000 women in their 40s will die of breast cancer over the next 10 years (ie, 996.5 of 1000 will not die of the disease).

Screening reduces the chance of breast cancer death from 3.5 to about 3 of 1000. In other words, 2000 women between 40 and 49 must be screened annually for the following ten years to save one life.

For most women with cancer, screening generally does not change the ultimate outcome; the cancer usually is just as treatable or just as deadly regardless of screening.

Finding cancers that were never destined to cause symptoms or result in death is the biggest problem with mammography, especially among younger women. Since it is impossible to know which cancers caught early are benign, all are treated with surgery, chemotherapy, radiation, or some combination. Overdiagnosed women undergo treatment that can only cause harm, and must live with the ongoing fear of cancer recurrence.

While only 7% of women believe there could be breast cancers that grow so slowly that leaving them alone would not affect their health, randomized clinical trials have consistently shown that the groups undergoing mammography have more breast cancer, even after 15 years of follow-up. This persistent difference represents overdiagnosis.

Estimates of the rate of overdiagnosis range from 2 women overdiagnosed for every breast cancer death avoided in one trial, to 10 to 1 in another.

Woloshin and Schwartz concluded: "The politicalization of medical care is wrong. Promoting screening irrespective of the evidence may garner votes but will not create healthier voters. People need balanced information. Simplistic slogans touting only the benefit are deceptive. Simple, standardized summaries about the benefits and harms of testing would help foster good decision making."

01-13-2010, 11:33 AM	#71
gdpawel Senior Member Join Date: Aug 2006 Location: Pennsylvania Posts: 1,080	Mammography Screening for Women Under Fifty The storm that greeted the USPSTF guidelines on mammography screening for women in their 40s prompted the Senate to insert a mandate in its health care reform bill that every insurer cover every mammography screening test at no cost to beneficiaries. The Journal of the American Medical Association (JAMA) published an article, "The Benefits and Harms of Mammography Screening: Understanding the Trade-offs," reminding physicians and women about the serious health costs of adopting that policy. The authors, Dartmouth's Steven Woloshin and Lisa Schwartz, used the "number needed to treat" analysis to point out: Without screening, 3.5 of 1000 women in their 40s will die of breast cancer over the next 10 years (ie, 996.5 of 1000 will not die of the disease). Screening reduces the chance of breast cancer death from 3.5 to about 3 of 1000. In other words, 2000 women between 40 and 49 must be screened annually for the following ten years to save one life. For most women with cancer, screening generally does not change the ultimate outcome; the cancer usually is just as treatable or just as deadly regardless of screening. Finding cancers that were never destined to cause symptoms or result in death is the biggest problem with mammography, especially among younger women. Since it is impossible to know which cancers caught early are benign, all are treated with surgery, chemotherapy, radiation, or some combination. Overdiagnosed women undergo treatment that can only cause harm, and must live with the ongoing fear of cancer recurrence. While only 7% of women believe there could be breast cancers that grow so slowly that leaving them alone would not affect their health, randomized clinical trials have consistently shown that the groups undergoing mammography have more breast cancer, even after 15 years of follow-up. This persistent difference represents overdiagnosis. Estimates of the rate of overdiagnosis range from 2 women overdiagnosed for every breast cancer death avoided in one trial, to 10 to 1 in another. Woloshin and Schwartz concluded: "The politicalization of medical care is wrong. Promoting screening irrespective of the evidence may garner votes but will not create healthier voters. People need balanced information. Simplistic slogans touting only the benefit are deceptive. Simple, standardized summaries about the benefits and harms of testing would help foster good decision making."