Breast cancer screening has been scaled back, according to the recent recommendations of the USPSTF.
That’s the right move. Although women aged 50 to 74 years should receive a mammogram every 2 years, evidence of breast cancer screening in other age groups has been marginally conclusive at best, and non-existent when it comes to clinical self-exams.
Furthermore, the guidelines implicitly acknowledge the downsides of cancer screening, including the possibility of biospies for eventual benign lesions, which introduces the risk of complications that more invasive studies bring.
In other words, evidence has been introduced into the guidelines, resulting in the recommendation for less testing.
Some patients, predictably, aren’t happy. I went through the comment section of the story in The New York Times, and found responses to be all over the map. Although some agree with the revised guidelines, the majority did not.
The reason being that a single case of life-saving, early breast cancer diagnosis will garner far more emotional airplay than the complications stemming from overscreening.
The thought that “more medicine is better testing” is so pervasive in the mindset of the American public that it’s going to be extremely difficult to scale back testing in this country. Even if it’s the right thing to do.
That’s the principal challenge facing health reformers today, who want to apply evidence, like results from comparative effectiveness studies, to medical decision making. Most doctors I know are already practice strict evidence-based medicine.
Whether patients accept this is still in question.