The United States Preventive Service Task Force (USPSTF) recently announced new recommendations on screening for breast cancer. The full report will not be available until later this year.

The summary statement acknowledges that mammogram screening reduces the mortality from breast cancer. As one ages, the chance of developing breast cancer increases. By the age of 82, one in eight women will have developed breast cancer.

The Task Force confronts the dilemma of screening, which is generally based on the likelihood of finding disease in a healthy population. This is the fundamental principle of preventive medicine, which can be very expensive.

Any test will have both false-positives (disease present but does not actually exist) and false-negatives (disease absent but actually present). The presence of disease at certain levels affects the false-positive and false-negative rates.

Every test performed in medicine can be viewed as screening or utilized to confirm a diagnosis. The key is to tailor the screening to the chance of finding disease.

Another concept in medicine involves the number needed to treat. For example, a hundred people may need to take a cholesterol medication to prevent one heart attack. Another example is that it takes one thousand pelvic ultrasounds to find one ovarian cancer.

The Task Force states "the precise age at which benefits from screening mammography justify the potential harms is a subjective judgement and should take into account patient preferences."  This could be said of any test. Patient's preferences should be based on sound science and recommendations of their health care providers.  

Medicine, already too expensive, would become unmanageable if we had a shotgun approach to all medical complaints based on the preference of the patient. The informed patient should be aware of the most appropriate and cost-effective approach to handle their particular medical condition. The best interest of the patient should be the guiding principle.  

In this brief summary, there were several concerning comments. First "older women face a higher probability of developing and dying from breast cancer but also have a greater chance of dying from other causes.  Women with comorbid conditions that limit their life expectancy are unlikely to benefit from screening."  Treating dead people certainly would be less expensive.

Breast cancer is second only to lung cancer as a cause of cancer-related death in women and "the risk of developing breast cancer increases with age beginning in the fourth decade of life." Interestingly, the Task Force recommends pushing back annual mammograms to fifty.  

Common sense tells us that the chance of surviving breast cancer improves dramatically with the earlier detection. Breast cancer mortality and morbidity has decreased every year since 1990. There will be unnecessary biopsies that are proven to be benign, but most women would trade an unnecessary biopsy for the diagnosis of breast cancer.  

I have too numerous to count examples of mammograms saving the lives of women. I wonder if the Task Force takes into account their contribution to society in total survivor years (taxes, child care, quality of life, and other unmeasurable intangibles). 

This is the beginning of health care rationing in the United States. The misuse of clinical data will be used for other screenings.  For example, colonoscopies could be pushed back to begin at sixty or even seventy. Prostate screening in the form of physical examination and prostate specific antigens could be pushed back further. 

Nearly every preventative test can be delayed until the incidence of disease is more common. 

We, as a society, have to determine the level of medical care that we can afford and that is necessary to insure the basic health care needs of all our citizens. The bloated health care bill going through Congress does not address these concerns. 

The failure to address individual responsibility such as obesity, tobacco use, and alcohol use is simply not fair to those that make an effort to live more healthy. Car insurance companies make irresponsible people pay more in premiums that those who drive responsibly. 

Finally, the composition of the Task Force is interesting. There were five family physicians, two doctorate nurses, one pediatrician, three internal medicine physicians, one scientist, one OBGYN, and several other non categorized physicians. There were no hematologists, radiation oncologists, or breast surgeons. 

The government has the ability to create the panels in a way to determine the outcome of the analysis. The views of each individual could be well known prior to recommending them to the panel. Data can certainly be manipulated to prove one's point.

Each American should let their representative how they feel about this subject.

Have a Great Week

Dr. Joe Edwards III M.D.