IT HAS been drummed into our culture, quite relentlessly and successfully, that early detection of cancer saves lives. So it stunned many doctors and breast cancer survivors this week when the US Preventive Services Task Force, a panel of health care experts appointed by the Department of Health and Human Services, upended its previous advice by recommending that most women begin getting routine mammograms at age 50, rather than 40.
There are many cautions behind the study’s headline recommendation: the guidelines aren’t intended for women at high risk because of family history or genetic makeup. And the task force doesn’t categorically instruct women not to get mammograms in their 40s. Instead, it says the decision should be left to women and their doctors, to be calibrated against each woman’s medical history and individual sense of risk.
But some oncologists worry that many women in their 40s will elect not to get mammograms at all - or that that insurance companies will seize on the guidelines as a reason not to cover the tests for women under 50.
These concerns aren’t far-fetched in an era of equal concern about health care and its costs. And while risk-benefit analysis can be a useful tool, the cold practice of statistical analysis shouldn’t play an outsized role in setting policy. In some slow-growing forms of cancer, overly aggressive treatment can indeed be more damaging than the disease itself. But when it comes to breast cancer, statistics suggest a clear, if modest, benefit to screenings at earlier ages. The American Cancer Society and the American Medical Association still recommend annual screenings beginning at age 40. Even Health and Human Services Secretary Kathleen Sebelius this week urged regular mammograms for women in their 40s, and emphasized that the task force does not set federal policy.
The task force says regular mammograms under age 50 will inevitably lead to false positives and follow-up tests, causing inconvenience and anxiety. But many women would gladly take those tradeoffs if they came alongside a greater chance of survival. And while the task force says they should feel free to make that calculation, there’s a danger here that women will be falsely reassured - or so fed up with statistical whiplash that they dismiss risk out of hand.
But the facts remain: Women in their 40s account for 17 percent of breast cancer deaths, and the incidence of breast cancer is increasing worldwide. The task force determined that screening 1,900 women over the course of a decade would prevent one cancer death. That would translate into thousands of lives saved every year - thousands of daughters, mothers, wives, and friends who would otherwise be lost too soon.
