Another call for delaying female cancer screening

This week started with a medical advisory body suggesting that women under 50 years of age stop getting regular mammograms. Today the American College of Obstetricians and Gynecologists announced guidelines that advise cutting back on Pap tests for cervical cancer and pushing back the age at which women are first screened.

Interesting that two calls for reduced cancer screening in women come in the same week while the nation is abuzz with talk of health care reform and finding ways to cut unnecessary medical spending.

Do you think that this is a coincidence, a sign that politics are at play in crafting these guidelines, or the result of sound scientific analysis of the risks and benefits of cancer screening?

Bob Grant -- Associate Editor, The Scientist

I think people don't want to hear difficult truths. The truths of these issues are that 1) many people are unnecessarily treated due to extensive screening programs, and 2) these treatments carry both direct and indirect costs which are a significant burden on individuals and society.

While everyone wants to tout the benefits of a national healthcare system vs. the evils of our current setup, the reality is that there are only so many resources and so many healthcare dollars to go around. As a society we have to prioritize these in some way. Our current method of prioritizing is to limit these resources to those who can afford them, presumably comprising the most contributory members of society. Another method, commonly used under national healthcare plans, is to simply limit the screening and treatment available to everyone across the board, with the exception of those with sufficient personal resources to leave the country for advanced care. There is no avoiding the equation, only different ways to balance it.

"Do you think that this is a coincidence, a sign that politics are at play in crafting these guidelines, or the result of sound scientific analysis of the risks and benefits of cancer screening?"

Bob Grant -- Associate Editor, The Scientist

Sadly, I do not believe that it is a coincidence that these two revised guidelines have been floated to the public at this time. Politics is not only at play but is writing the rule book.

I trust that the recommendations were made strictly upon a review of the medical evidence that is available. Economic factors were not part of the considerations. What clearly has been political is the rejection of them by Sec. Sibelius. Once again medicine by interest group triumphs.

WashPost Business columnist Steve Pearlstein calls it a major setback for health reform and to the concept of evidence based medicine in a must read piece today.

http://www.washingtonpost.com/wp-dyn/content/article/2009/11/19/AR2009111904053.html

Bob Roehr

interesting post.....

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Try and suggest this to women whose lives have been saved by early screening! Yes, the issue is to save money! One agrument against pre-50 breast cancer screening was that it lead to painful procedures that were often unessessary since resuts were often negative. But what about those whose results came back positive? I thought the idea of screening was to SAVE lives. Postponing these test may save money and discomfort but is it worth the lives of those who benefit from the earlier screenings? Maybe we should ask their families.

A large part of the problem is the blanket recommendations.

Instead of saying EVRY women over age-X needs a mammagram every year, they should publish a list of risk factors with weighting factors and have programs that calculate risk for individuals.

If Travellers can use actuaries to estimate risk for drivers (teens who are honors students get cheaper rates, etc.) then medical experts can do the same.

The risk factors are known. The general weight of these risk factors - also known.

If we can produce computer models that map the oceans, predict the weather and assess seismic data, we can produce computer models to assess an individual's risk - and therefore need for screening.

Instead we have guidelines that change and a panicked public who can't assess risk about anything with any reason. (How many people fear flying, but not driving when the relative risks do not compare?)