Any woman who has had a mammogram knows that it¡¦s an iffy, worry-inducing test.The scans sometimes miss tumors, and they sometimes mistake harmless images for cancer, but women 40 and older, following standard medical advice, go ahead and get them anyway because there isn¡¦t any better way to detect breast cancer early. Better to risk a false positive than not to discover a lesion that can kill you.
Or so went the thinking until the other day, when an influential federal task force turned that reasoning on its head. It repudiated the mantra that doctors and public-health advocates have been chanting for years: Do a self-exam once a month. Get a mammogram annually.
The task force now says that most women in their 40¡¦s don¡¦t need routine annual mammograms and that older women can cut back to every other year. The independent panel of doctors also recommends against teaching women how to examine their breasts.
In other words, women should just chill out. The task force¡¦s rationale--which hasn¡¦t been embraced by the medical establishment--is that yearly exams and self-screening leave too many women needlessly anxious and prompt unnecessary follow-up procedures. The few lives that are saved by screening, said the committee, don¡¦t justify the strain on everyone else. Women, a task force member said, should be aware of those limitations before getting a mammogram.
Of course, they should, and for the most part, they are, which has to leave you wondering why the U.S. Preventive Services Task Force felt compelled to trout out recommendations that invite devastating consequences:
„P More cancers will go undetected.
Granted, the committee has some math on its side. It said that only one life is saved for every 1,904 mammograms of women in their 40¡¦s, so, the vast majority are wasting their time, but try telling that to the women whose lives were saved by early detection. Many women already find mammograms uncomfortable and intimidating. They only need a little shove to decide against having them. Is this really the direction the country wants to move on a disease that is expected to kill more than 40,000 women this year?
„P Not all breast cancers are equal.
Some are extremely aggressive, in fact, so aggressive that getting an exam every two years instead of every one will, in some cases, make a life-and-death difference.
„P Insurance coverage.
While the task force said its recommendations have nothing to do with insurance coverage, its advice could well spur insurers to cut back coverage for annual screenings, particularly for women younger than 50.
That could leave some women with a family history of cancer or other risks left to fight for a needed mammogram.
Breast cancer is not the only place this sort of reasoning is being applied.
Recent studies of screening for prostate cancer suggest that the collective benefit does not justify routinely testing every man older than 50, as is done today, but you won¡¦t find many 50-plus urologists opting not to test themselves. When a simple blood test can save your life, who cares about averages?
Similar logic is also sure to be widely applied in other areas as the country tries to rein in runaway medical costs.
On an academic level, this is interesting and potentially useful. It might lead to better tests, or fewer tests, in non-life threatening circumstances, but, if you¡¦re only one patient trying to detect a deadly disease, it¡¦s just something to muse about--on your way to getting your mammogram.
