Is it the first move of a conspiracy to ration medical care, or is it a long-overdue effort to reduce the harm of overtreatment, based on irrefutable statistical evidence? The Washington Post responds to the great confusion over new guidelines for breast cancer screening (no routine mammography screening for women in their 40s and less-frequent screening for older women) with a Q&A with Kay Dickersin, director of the U.S. Cochrane Center and the Center for
Clinical Trials at the Johns Hopkins Bloomberg School of Public
Health. In 1997, as a member of the National Cancer Advisory Board,
Dickersin voted in favor of a similar recommendation for less
screening. She also received a diagnosis of breast cancer in 1986.
Here's a very brief summary of Dickerson's take on the issue:Mammography's benefit in terms of saving lives is very small for
women 40-49. The cost of a mammogram is not
just money, it is also harm to the woman. In a low risk population,
such as women 40-49. A mammogram results in many false positives and
this is an important potential harm.A false positive means that a woman is told that the mammogram shows
something that makes the doctor concerned that there could be a
problem. Because she or he is not sure, the doctor tells the woman she
needs to have additional mammograms or an MRI. And some women go on to
have a biopsy because the additional images still show a possible
problem. Being told that she needs additional images often results in
worry for the woman. Dickersin says it's important to remember that mammography doesn't prevent breast cancer, it merely detects it. And
detecting it earlier doesn't necessarily mean a life is saved or even
extended.
Read more of what Dickensin has to say in the Washington Post.
Dickensin states, “That is what the review is saying: Except in a few cases, we cannot credit mammography with savings women’s lives in the 40-49 age group”.
However, even the review states that screening mammography reduces the death rate for breast cancer in the 40-49 age group by 15%. This is the same death rate reduction that is achieved in the 50-59 age group. I wouldn’t refer to a 15% reduction in the death rate as a few cases.
So all of the jury rewards made to plaintiffs for delayed diagnosis related to interpretation of mammograms should be reversed?
The recent discussions about screening mammography have not said anything about medical/ legal issues or tort reform.
The evidence is solid that screening mammography in the 40-49 age group reduces the death rate from breast cancer by 15%.