Tuesday, November 17, 2009

USPSTF Breast Cancer Epidemiology Nonsense

The United States Preventive Services Task Force (UPSTF) has published new breast cancer screening guidelines in the Annals of Internal Medicine. The USPSTF is not a government agency. It is an independent body financially supported by the Agency for Healthcare Research and Quality which is a federal agency. The new guidelines are a bit surprising and I am sure will generate a lot of controversy.

The new guideline recommendations are:

Against teaching breast self examination.

Against routine mammography screening for women age 40-49.

Women age 50-75 years old should have biannual rather than annual screening mammography.

Insufficient evidence to determine the benefits and harms for clinical breast exams

Insufficient evidence to determine the benefits and harms of screening mammography after age 75.

Insufficient evidence to determine the benefits and harms of digital mammography or MRI vs film mammography screening

How did they come up with this? This was determined after a meta analysis of all studies that were identified through the Cochrane Register of Controlled Trials, the Cochrane Database of Systematic Reviews, a MEDLINE search from January 2001 to December 2008, Web of Science searches, and the Breast Cancer Surveillance Consortium for screening mammography. The problem with such meta analysis studies is that they often miss the trees for the forests. They compile statistical data but do not take into account the great individual and even group differences that can be widely different and need different recommendations. The guidelines are made for everyone and that is how we end up with what I call epidemiological nonsense.

Women -don't do self breast examinations? Doctors - don't do clinical breast exams? It may do more harm than good? Don't do mammography screening for women ages 39-49 even though this analysis even shows that mammography screening in this age range results in a 15 % decrease in breast cancer mortality rates? This is nonsense . Our faith in and dependence upon large scale meta analyses has led to absurdities such as these USPSTF guidelines. These guidelines are not just absurd, they are dangerous. Women will be confused about what they should do and because of this confusion women will die who would not otherwise. These guidelines will encourage insurance companies to deny payment for mammograms until age 50. At least women can appeal these denials. Under a government run health care system there would be no recourse.

I am interested to see what other health organizations including the American Cancer Society will have to say.

Thought for the day

" Cast your anxieties upon the Lord as He cares for you"

St. Peter


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