Guidelines On Cancer Screenings Spark Debate

New guidelines on mammograms and pap smears set off a fierce debate. The New York Times reports: "Two new recommendations, calling for delaying the start and reducing the frequency of screening for breast and cervical cancer, have been met with anger and confusion from some corners, not to mention a measure of political posturing. The backers of science-driven medicine, with its dual focus on risks and benefits, have cheered the elevation of data in the setting of standards. But many patients — and organizations of doctors and disease specialists — find themselves unready to accept the counterintuitive notion that more testing can be bad for your health."

On Monday, the United States Preventive Services Task Force recommended that routine mammograms start at age 50 instead of 40, that women receive the test every two years as opposed to annually, and that physicians no longer train women to perform breast self-examination. Meanwhile, "On Friday, the American College of Obstetricians and Gynecologists plans to announce a similar revision to its screening guidelines for cervical cancer. It will advise that women receive their first Pap test at age 21; the previous standard had been three years after a woman's first sexual intercourse or age 21, whichever came first. The group also is recommending that the test be performed every two years instead of annually for women ages 21 to 30. ... The challenge of persuading patients and doctors to accept such standards requires a transformational shift in thinking, particularly when the disease involved is as prevalent, as deadly, and as potentially curable as cancer" (Sack, 11/20).

In a separate article, The New York Times reports: "The federal Preventive Services Task Force, the group that created a political firestorm this week with its recommendation that women get less-frequent mammograms, was created to be insulated from politics. Yet, some observers say, its apolitical nature may have made it naïve about just how strongly Congress; some professionals, like radiologists; advocacy groups, like the American Cancer Socieety; and members of the public would react. ... Republicans and some groups, like the American College of Radiology, said the guidelines were made in response to the Obama administration's wish to save health care dollars."

"The health and human services secretary, Kathleen Sebelius, distancing herself from the group's recommendations, told CNN on Wednesday, 'This panel was appointed by the prior administration, by former President George Bush.' Dr. Diana Petitti, the vice chairwoman of the task force, said Thursday that she had been taken aback by the reaction. ... Panel members said politics and questions of cost were never part of their discussions of the risks and benefits of mammograms — in fact they are prohibited from considering costs when they make guidelines" (Kolata, 11/20).

The Wall Street Journal reports that the task force clarified their position on screening: "Seeking to dispel confusion over some aspects of the new guidelines, task-force members said they never meant to convey that women in their 40s shouldn't get mammograms, nor that they sought to discourage women from examining their breasts for signs of cancer. Diana Petitti, a professor in biomedical informatics at Arizona State University who is vice-chairwoman of the panel, said she felt its conclusions were misinterpreted." Petitti said the task force "is in favor of women in that age range deciding on their own, after consulting with doctors" (Wang, Rockoff and Martinez, 11/27).

NPR reports on how the backlash worries evidence advocates: "Take a step back from the heated debate over when to start routine mammography and consider the broader implications for efforts, championed as part of health care overhaul, to root medical decisions in the best available science." NPR cites bloggers and writers comments on the backlash's implications (Hensley, 11/19).

Bloomberg reports: "The furor over a federal panel's recommendation against mammograms for most women in their 40s shows the obstacles the U.S. may face trimming costs in a $2.5 trillion health system, even when research suggests the cuts may be appropriate, said Uwe Reinhardt, a Princeton University economist. ... Americans want low costs, access to all procedures and technological advances without regard to income, all of which can't co-exist, said Reinhardt, one of 23 economists who urged Obama in a letter Nov. 17 to make sure Congress includes 'additional funding for research into what tests and treatments work and which ones do not'" (Nussbaum, Wechsler and Gaouette, 11/20).

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