Only a Bureaucrat Would Argue That Fewer Cancer Screenings Means Better Results
It’s been all over the news, but I went to an ostensibly authoritative source for details. This is what Clinical News in Oncology and Hematology has to say about the federal government’s recent decision to recommend biennial mammograms starting at age 50 rather than the prior recommendation of age 40. Emphasis (except in the headline) is mine.
Biennial mammography initiated at age 50 achieved most benefits of annual screening
An analysis of 20 screening strategies using various mammography screening schedules and age groups suggests that biennial screening for women aged 50 to 74 provides nearly all the benefits of annual screening with fewer false-positives.
[ . . . ]
Across the models, screening biennially yielded 67% to 99% of the benefits of annual screening — an average of 81%. Screening biennially also led to a reduction in false-positive results by nearly half. The researchers also reported that screening biennially from ages 50 to 69 led to a median 16.5% reduction in breast cancer deaths compared with no screening.
Initiating biennial screening at age 40, compared with age 50, reduced mortality by another 3% (range, 1% to 6%); however, screening at this age also used more resources and led to more false-positive results, according to the CISNET resaserchers. The researchers also reported that annual screening from age 40 to 69 would lead to 2,250 false-positive results for every 1,000 women screened — almost double that found with biennial screening in this age group. In addition, 7% of women who receive false-positives results would undergo an unnecessary biopsy. If screening begins at age 40 and is performed every other year, mortality reduces by a median 19.5% compared with beginning screening at age 50, but false-positives, unnecessary biopsies and anxiety increase.
Sorry to be blunt, but this is a stupid report, for a number of reasons. First, of course testing less frequently yields fewer false positives. What the report leaves out is that it also yields fewer early diagnoses.
Second, the story acknowledges that the breast cancer mortality rate decreases 3% with annual screening versus biennial screening. But more frequent screening also likely produces better results for survivors as well, since earlier diagnosis reduces the need for more invasive treatments such as mastectomy and more aggressive chemotherapy and radiotherapy required when cancer has spread.
Third, while avoiding the anxiety of a false positive and avoiding unnecessary and painful biopsies is certainly a benefit, neither anxiety nor a biopsy is likely to cause death. Poll 100 women, and I guarantee you a large majority would rather have the anxiety of a false positive than the anxiety of a cancer diagnosis that could have been made earlier for a better outcome. Ditto for the discomfort of a biopsy versus that of treatment for more advanced cancer.
Fourth, to cite cost as a benefit that outweighs patients’ lives is not only offensive but, in my view, amoral.
Watch this study be used by insurance companies to refuse coverage for mammograms. And if Obamacare passes, watch the feds use it to restrict coverage by the proposed government option as well.
Full disclosure: I had my first mammogram in my early 30s after finding an abnormality during a self-exam. It turned out to be nothing, but I learned then that I have denser than average breast tissue and a propensity toward fibrous cysts, both of which can make it harder to feel a tumor. That puts me at higher risk for a delayed diagnosis if. My maternal aunt was subsequently diagnosed with breast cancer, which adds to my. For those two reasons, I began having annual mammograms at age 40. I am now in my mid-40s. I take this study as a personal attack on my future health and well-being.
One additional note: The digital mammography image at the top of this post is not mine.