November 20th, 2009

Reports the Philadelphia Inquirer:

Common sense tells women that while mammography is an imperfect, inadequate defense against a disease that will kill 40,000 of them this year, it is better than nothing.

No wonder new breast-cancer screening guidelines issued this week by the U.S. Preventive Services Task Force went over with a thud.

In a reversal of previous advice, the expert panel concluded that women in their 40s who are not at high risk for breast cancer should forgo mammography because the benefits minus the harms are small. The panel stressed, however, that the decision “should be an individual one” and “take into account the patient’s values.”

To a lot of people, the recommendations sounded like the panel thought the “benefit” of saving a fortysomething woman’s life was not worth the “harm” of anxiety, extra tests, and costs resulting from suspicious mammograms that turn out to be false alarms. And that kind of statistical modeling seemed colder than the breast-squishing metal of a mammography machine.

“We’re willing to accept a lot of false-positive mammograms to save one woman’s life,” said physician Therese Bevers, who chairs the breast-cancer screening-guidelines panel of the National Comprehensive Cancer Network, based in Fort Washington. “The people who did this modeling are statisticians. They don’t treat breast cancer.”

Marisa Weiss, the Narberth breast-cancer oncologist and founder of breastcancer.org, said the guidelines’ trade-offs may seem acceptable when “expressed as nameless, faceless numbers,” but “it also means 3 percent more women would die from breast cancer each year.”

The firestorm has been so intense that on Wednesday, Health and Human Services Secretary Kathleen Sebelius – head of the federal agency that sponsors the task force – backpedaled, saying the new guidelines had created confusion. Federal mammogram policies, she said, would not be changed, and she did not expect insurance companies to change coverage.

Even though the task force was appointed during the Bush administration and does not consider costs in making recommendations, its work has become fodder for debate over health-care proposals championed by President Obama. Opponents of the health-care overhaul have tried to paint the guidelines as a foretaste of dire changes, such as health-care rationing, if the federal overhaul happens.

Read more at the Inquirer.