In November, the Preventive Task Force issued recommendations advising primary care physicians against recommending mammograms to women under 40 years of age. While the guidelines were the result of comprehensive scientific review of the benefits of mammogram testing for women under 40 and have no bearing on coverage decisions, Republicans presented the Task Force as a poster child of health care rationing and even introduced and approved an amendment that essentially disregarded the task force’s recommendation. Many Democrats also voted for the measure.
But now, a new study published in the Journal of National Cancer Institute confirms that politicians should not interfere with science. Researchers tracked the records of “more than 117,000 women who had their first mammogram before 40, and the results support today’s guidelines for average-risk women.” The study found that “in a theoretical population of 10 000 women aged 35–39 years, 1266 women who are screened will receive further workup, with 16 cancers detected and 1250 women receiving a false-positive result.” From the study:
In our population, a substantial percentage of young women [under 40] received screening mammography, but few breast cancers were found, regardless of their specific age, race, or individual characteristics. Yet, these women experience high recall rates with high rates of additional imaging. The sensitivity, specificity, and screening positive predictive value of screening mammography were poor, and cancer detection rates were very low in these young women, who are not yet in an age group for which national organizations recommend regular screening mammography. Harms need to be considered, including radiation exposure because such exposure is more harmful in young women the anxiety associated with false-positive findings on the initial examination, and costs associated with additional imaging.
Undoubtedly for some younger women, an early mammogram is a life saver, but for the majority, it’s an unnecessary test that raises stress levels and contributes to skyrocketing health care costs. Government guidelines can reflect this reality without constraining the doctor. She or he can use the recommendations as just one piece of data among many that could help guide physicians in treating individual patients.
After all, 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, and politicians shouldn’t pretend it can (while also complaining about rising health care costs).