Wednesday, November 18, 2009

USPSTF Breast Cancer Epidemiology Nonsense Part 2

Yesterday I briefly discussed the new breast cancer screening guidelines published by the United States Preventive Services Task Force (USPSTF). The USPSTF is not a government agency but is funded by the federal government and operates under a congressional mandate. The highlights and controversial aspects of the recommendations are:

Against self breast examination

Uncertainty about whether a doctor's clinical breast exam does more harm than good

and the main one- recommendations against routine mammography screening for women age 39-49

Both the American Cancer Society and the American College of Obstetrics and Gynecology have written responses challenging these new guidelines. Why the challenge? The USPSTF report indicates that screening mammography for women in their forties does more harm than good. The report indicates that 1339 women in their 50's need to be screened to save one life and that 1904 women in their 40's need to be screened to save one life. With 22,327,592 women age 40-49 in the United States as of July 1, 2008 the difference between 1339 and 1904 seems pretty small to me. 17% of all breast cancer deaths each year are in women diagnosed in their 40's. Over 45,000 deaths from breast cancer occur in women age 40-49 over a 10 year time span.

The USPSTF report acknowledges that the benefits of screening mammography for women in their forties are the same as for those in their 50's with a mortality risk of 0.85 from 39-49 and 0.86 for women in their 50's. But because of the total smaller number of diagnoses in the 40-49 age range and more false positives the USPSTF believes that due to "anxiety, distress and other psychosocial effects" the risks outweigh the benefits. I believe that the anxiety and distress caused by learning of a breast cancer that could have been diagnosed earlier far outweighs the anxiety of a false positive mammogram. The only psychosocial benefit in not screening women in their 40's is cost reduction.

I would welcome any thoughts or comments on this issue.

Thought for the day

One day at a time.

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