A government panel's recommendation last fall that women start routine mammograms at age 50, not 40 and that doctors shouldn't bother teaching breast self-exams, set of a firestorm of controversy and much confusion.
Well, the uproar isn't over.
Doctors and patients disagree about the guidelines, with doctors more likely to adopt the new recommendations and patients more apt to reject them, a new editorial in today's Annals of Internal Medicine reveals.
The editorial includes the results of a survey of 651 people, about 60 percent were physicians or other medical professionals and nearly 40 percent were members of the general public.
Some 67 percent of medical professionals said they would stop offering routine mammograms to patients in their 40s. Another 41 percent say they would stop advising patients to do breast self-exams.
Women thought otherwise. About 71 percent said they were very or somewhat unlikely to forgo routine screening in their 40s, no matter what their doctor recommended.
The findings underscore the complexity of the debate, the editorial goes on to say. Breast cancer on its own is emotional. Everyone knows someone touched by the disease. Add the new guidelines, and you've got the makings of a confusing, politically-charged discussion that has yet to be resolved. (Indeed, some feared insurance companies would no longer cover the screening, others predicted it was the beginning of rationing, and politicians moved to get legislation passed to guarantee women get mammograms starting at 40.)
So, now what?
The editors at the Annals of Internal Medicine come to the defense of the task force saying that even though people claim mammograms save lives, "only a fraction of abnormalities initially detected on mammography and subsequently treated truly represents a life saved rather than unnecessary or premature treatment."
The editorial stresses that the task force's goal was to issue guidelines, not a "one-size-fits-all" recommendation for screening. It intended to spark a rational discussion about the harms, risks and benefits of screening, not a political uproar about rationing care, the editorial states.
It's a fascinating debate. Few other recommendations by the U.S. Preventive Services Task Force have sparked such a reaction. No one flinched when the USPSTF advised against routine depression screening, even though depression is more common than breast cancer, the editorial explains.
But breast cancer is not depression. Just a glimpse at the letters the journal received in response to the guidelines -- from "I am furious!" to "What a relief"-- reveal how on this issue, medicine, politics and emotions collide.
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