These guidelines are based on actually science, in as much as any guidelines can be based on science.
Here is a rational discussion (by an actual doctor and scientist, instead of by fear-mongering idiots on the interwebs.
http://scienceblogs.com/insolence/2009/11/really_rethinking_breast_cancer_screenin.phpSo what are the harms of screening? First, there are "unnecessary" biopsies. I used quotation marks because we don't know that the biopsies were unnecessary except in retrospect because our imaging technology is not good enough to differentiate benign from malignant as well as we would like, with as many as 80% of biopsies being negative. Second, as I've discussed before, there is a significant rate of overdiagnosis. Overdiagnosis is the detection of tumors that would never lead to life-threatening disease over the lifetime of the woman. Overdiagnosis leads to over treatment because, again, we can't identify which of these diagnosed tumors will and won't progress; so we have to treat them all. The question then becomes: What is the risk-benefit ratio of screening. For ages 40-49, the analysis of the results by the USPSTF showed a 15% reduction in breast cancer mortality, which was similar to the risk reduction for women aged 50-59 while the risk reduction was 32% for women aged 60-69 However, given the lower incidence of breast cancer in the younger age range and the higher chance of false positives and overdiagnosis, the absolute number of lives saved is considerably smaller and comes at a higher cost.
But enough of all these numbers. From my perspective, these new recommendations are a classic example of what happens when the shades of gray that make up the messy, difficult world of clinical research meet public health policy, where simple messages are needed in order to motivate public acceptance of a screening test. It's also an example where reasonable researchers and physicians can look at exactly the same evidence for and against screening at different ages and come to different conclusions based on a balancing of the potential benefit versus the cost. The USPSTF simply came down on a side more like how many European nations screen for breast cancer. Depending on how women undergoing screening and we as a society balance the risks and benefits of screening, how this all plays out is an open question. The only prediction I can make is that the standard of care for breast cancer screening will almost certainly change. I doubt it will change all the way to the USPSTF's new guidelines, but likely they will move in that direction, although I cannot predict how much. In any case, it's always messy when that happens and leads to blowback. For instance, a professional society to which I belong issued a highly embarrassing press release, a case study in the wrong way to respond to a new set of recommendations like this. The worst part of this press release was this:
SNIP
And other post by the same person:
http://scienceblogs.com/insolence/2009/11/obamas_makin_death_panels_for_your_mama.phpOne day later, I realize that the example of a brain dead and hyperbolic attack of the new guidelines was nothing compared with what was to come and, I suspect, still is to come. Although some attacks are just misguided and based on erroneous information, a lot of them are truly nothing more than appeals to emotion and logical fallacies. Indeed, the stupid is flaming fast and furious, flowing down the sides of the volcanoes of stupid spewing forth lots of heat, until the lava of stupid is finally lapping at the last walls defending rational discourse over what is a very difficult issue, both in terms of science, medicine, and policy. In fact, some of the attacks on the new guidelines carry distinct echoes of the same rhetorical techniques of Mike Adams and Joe Mercola. They have been truly painful to read, so full of neuron-necrosing nonsense that I wonder if those conspiracy theorists in tin foil hats might have a point, even though I realize that mere tinfoil will not stop such powerful waves of stupid. Worse, a lot of the press coverage has given free rein to the very same sorts of flaws that so irritate me in the coverage of alternative medicine.
Let me just say right now that I am more forgiving of the press coverage that emphasizes anecdotes over data, stories like this one, which follows a pattern that I've seen emerging in the coverage of this story, namely the highlighting of an anecdote of a woman under 50 (or even under 40) who had a breast cancer that was detected either by screening mammography or by self breast examination. Another example is this story. This is lazy journalism at best, where finding the "human interest" angle trumps a science-based discussion of the pros and cons of the new recommendations, what they mean to women, and how they might be applied. It's the triumph of pure emotion over science. Meanwhile, Congress is getting involved, specifically Rep. Debbie Wasserman Schultz (D-FL), who is threatening to hold Congressional hearings on the matter. (Now there's something that'll shed a lot of light on the science!) Wasserman is a breast cancer survivor; so I can understand her emotional investment in the issue. I can understand the emotional involvement of anyone who's life has been touched by cancer. Unfortunately, she's just plain misguided to try to meddle in the development of science-based medical guidelines this way. Her activities are far more likely to interfere with the scientific debate that must occur now regarding screening than they are to facilitate a new scientific consensus based on the strongest data available.
I've made my position clear on the new guidelines. They are imperfect and most definitely do not mean that women under 50 should not be screened. Rather, they will most likely serve as reasonable, albeit flawed, starting point for a debate that has been brewing for the last several years as more and more studies have questioned how beneficial screening mammography is for younger women relative to its risks and documented the problems of overdiagnosis and overtreatment. I've also pointed out how I know that women will be confused by this change. In fact, if anything failure to communicate such a monumental change in recommendations in a manner that would mitigate some of this controversy is clearly the USPSTF's biggest failing in the matter. The task force did an absolutely execrable job of laying the groundwork for its announcement, so that it didn't appear to come out of nowhere. Even so, as I said before, an update of our screening guidelines was expected, and there is much to discuss. However, there is a relentless drumbeat of attack that is not based on science and strikes me as knee jerk. Some of it is downright idiotic; there's just no other way to put it. I feel obligated to address it because, as a skeptic, I find such bad arguments and misinformation an offense to my intelligence.
Overall, the idiocy falls into three general categories:
1. The misogyny gambit
A disturbing tack being taken towards the guidelines is the misguided urge to cry, "Misogyny!" No, I'm not saying that there hasn't been misogyny issuing from the government and other regulatory and academic bodies over women's health before. There's been a fairly long history of that, and we are only starting to overcome it. I'm just saying that this isn't one of those times. The problem with this gambit is that those invoking it jump on news reports about the task force report without actually having read the report. For example, Feministing described the guidelines thusly:
SNIP
2. We're going to turn into a Third World country with women showing up with big nasty incurable cancers.
Another seriously deluded attack (not to mention a form of "slippery slope" fallacy) is the overblown expression of fear that, if these new guidelines were to take hold, American women would be relegated to the same status with regard to breast cancer screening as sub-Saharan Africa.
SNIP
3. Obama's settin' up death panels to kill grandma
Like an undead zombie that just won't stay dead, the difference being that even if you shoot it in the head it keeps getting up again, the "death panel" lie keeps shambling on, to eat the brains of many a pundit and make them just as ignorant as Sarah Palin, the populizer of this myth. The timing of the USPSTF's recommendations, released right in the middle of a major political battle over reforming our health insurance system and providing a government-funded option to insure the uninsured, is very unfortunate in that it's given free rein to conspiracy theorists, the wildest of whom think that the USPSTF's part of a plot by the government and the cleverer of whom see it as some insidious infiltration of some sort of vile health care rationing. Here are some examples:
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