Backlash Over Mammogram Guideline 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.

You probably know by now about the American Cancer Society's disagreement with a federal task force's recommendation that women start routine mammograms at age 50 instead of 40.

Dr. Otis Brawley, the cancer group's chief medical officer, called the guideline a "step backward" in an editorial in Thursday's Washington Post because it overestimates the risk and underestimates the benefits of mammography for fortysomething women.

Breast cancer remains the leading cause of cancer death among women age 40 to 49, claiming more than 4,000 lives a year, Brawley writes. Despite its limitations, annual mammography for women in their 40s is the best tool available to curb breast cancer deaths.

What's more, Health and Human Services Secretary Kathleen Sebelius declared the task force guidelines won't alter federal payment for mammograms. The U.S. Preventive Services Task Force, she said Wednesday, "does not set federal policy, and they don't determine what services are covered by the federal government."

Too bad, writes health journalist Merrill Goozner, a voice for the dissent. Of the 4,000 or so breast cancer deaths of women in their 40s annually, mammography would save 600, at the most. But to get that benefit, more than 1 million women a year would have to be screened for a decade.

That sort of mass screening is expensive, and by the calculation Goozner explains in his blog post, would run more than $2 billion annually. Just think what could be done if that money was used more wisely--free mammograms for women at high risk and cancer prevention, he says.

New Hampshire internist Dr. Kevin Pho, who writes and blogs prolifically, sees the backlash against the recommendation as a broader blow to work on grounding medicine in the best evidence.

The mammogram mess bodes poorly for the nascent efforts to make comparative effectiveness research an important tool in health overhaul to sort worthwhile health care from the wasteful and inferior.

As Pho concludes:

If recommendations from an entity like the USPSTF -- as non-partisan and robust as it gets -- gets so much resistance from doctors, patients, and even the government itself, findings from a comparative effectiveness body stand absolutely no chance of changing medical practice.