The Case For Recommending Mammograms To Women Over 50

breast_cancer_ribbonLawmakers and some doctor and patient groups are criticizing the “new guidelines from a government task force that recommends against routine mammograms for women under 50.” The U.S. Preventive Services Task Force advises doctors against routinely providing the service to women under 50, but notes that “there may be considerations that support providing the service in an individual patient.”

For the average female population, mammograms cause more harm than good:

The harms resulting from screening for breast cancer include psychological harms, unnecessary imaging tests and biopsies in women without cancer, and inconvenience due to false-positive screening results. Furthermore, one must also consider the harms associated with treatment of cancer that would not become clinically apparent during a woman’s lifetime (overdiagnosis), as well as the harms of unnecessary earlier treatment of breast cancer that would have become clinically apparent but would not have shortened a woman’s life. Radiation exposure (from radiologic tests), although a minor concern, is also a consideration.

The debate underscores the complexity surrounding public health care management and raises new challenges for comparative effectiveness research. More immediately, the new guidelines create a political dilemma: clinical trials suggest that mammograms don’t work very well for younger women with thicker breast tissue. The test yields more false positives, anxiety, and over treatment (that itself can lead to more serious health problems) than saved lives. It also drives up health care costs.

Undoubtedly for some women, the mammogram is a life saver, and lawmakers fear that insurance companies will seize the new guidelines to deny coverage for mammograms for younger women. But the Prevention Services Task force had a choice. It could have issued a recommendation that would have 1) hurt the majority of the under 50 population, 2) helped a small number of women, but 3) added to skyrocketing health care costs. Or it could have issued a recommendation that would have 1) benefited the majority of the under 50 population, 2) didn’t create more waste in the system and 3) harmed a small percentage of women. Only in the world of political rhetoric can one test everyone and improve all health outcomes.

At the end of the day, health care providers need to follow scientific protocols. The system can’t accommodate a situation in which doctors order CAT scans for simple headaches or complicated surgeries for problems that can be solved with a regimen of medication. Policy makers must balance risk and benefit because a free-market approach creates the kind of health care costs that price millions out of the health insurance market. It produces a situation where 46 million Americans are uninsured, 45,000 die every single year because they don’t have health insurance, while the nation spends 16% of it’s GDP on health care and $800 billion/year on health procedures that actually worsen health outcomes.

In a situation with no good answers, scientific research should inform the best answer.