Sunday, November 22, 2009

Before we cast stones, let’s look at science

Whenever something new challenges conventional wisdom or standard practice, sparks will fly.

That’s what happened this week after a federal panel advised against routine mammograms for women under 50.

The initial reaction was quick and explosive. The government, skeptics say, wants to save a dollar at the expense of women’s health. Some even smelled the putrid waft of insurance companies trying to keep more of their premium pie as they lurk in the shadow of health care reform.

Healthcare providers say the recommendation could set women’s healthcare back decades as those who would rather avoid the discomfort of a mammogram forego the test. Everyone predicts more women will die unnecessarily.

It’s understandable. We all know someone under 50 who was diagnosed with breast cancer. It may have been our mothers, our friends, ourselves or even our daughters.

We have been told time and time again that our best defense against disease is early detection.

Screening, the way we’ve always done it, we believe saves lives.

But what if it doesn’t?

What if instead, the amount of radiation healthy women accumulate from a decade of better-safe-than-sorry screenings, in fact, makes us more prone to cancer?

What if the type of cancer has more to do with our survival outcomes than just the size of it?

What if improving routine care was better?

While each of us has a story about a woman diagnosed with cancer after a routine mammogram, how many of us know people whose cancers the mammogram missed?

It happens, especially in younger women because their breast tissue is dense, making reading the tests more difficult.

According to a German study published in the British Journal of Cancer in 2007, while it appears more cancer cases are found within quality screening measures, the correlation to better outcomes couldn’t be made. The study also found that a similar amount of breast cancer cases are detected outside of mammographic screening.

While it seems true that highly technical and scientific standards in diagnostic mammography, including expert reading can improve detection of cancers, fully two-thirds of all cancers are found initially through standard care – namely clinical examination and self breast exams.

No one wants to think of their health in terms of risk and reward. No one wants insurance companies to start barring women from potentially life-saving screenings.

But by the same token, we should be pushing the scientific envelope and finding better diagnostic tools, not just tools that are good-enough.

After all, it’s not uncommon to find women who fall outside of all guidelines — in their 20s and 30s — being diagnosed with breast cancer. By sheer virtue of that, one might think we should roll forward the age of screening instead of shoving it back, yet we must ask ourselves what are the risks? What are the rewards?

It seems pretty clear that mammography has been a good diagnostic tool to detect breast cancer in women since its invention in the 1960s, but it shouldn’t be the only tool in the arsenal.

Would we fear this if we didn’t all picture our insurance carriers foaming at the mouth and planning their Christmas bonuses at the savings they’ll reap at our expense?

I don’t think any of us should jump to conclusions just yet. We keep asking questions and have an open mind. If we don’t we run the risk of shutting down scientific advances to keep status quo.


Heather said...

Thank you for this. It helps me to see the other side when all the news organizations seem to be throwing only one side at us.

Bill said...

Now, now...that's enough of the calm talk. We need panic, now! ;)

This is a nice post. I've wondered how these recommendations would have been taken if they'd come out a year ago, before we were talking about insurance reform and all of that.