Tuesday, November 17, 2009

Cancer screenings, Part 2

Since my last posting about cancer screenings (conveniently linked for a little refresher), new information has come out about breast cancer screening.

The U.S. Preventive Services Task Force, the panel in charge of determining preventive services standards, has deemed that mammograms should begin at age 50 instead of the previous recommendation of 40. It also recommends that screenings be conducted every 2 years instead of every year; the harms are greatly reduced while the benefits remain the same.

Here is a link to the USPSTF recommendations.
NPR had a big story this morning about this topic.
The Annals of Internal Medicine outlines the data that went into this decision.

The basis for this updated recommendation is that screening too often and too early can lead to unnecessary testing of any abnormal result, which can cause physical and psychological harm. The risk of false positives also pose psychological harm. The New York Times writes, "while many women do not think a screening test can be harmful, medical experts say the risks are real. A test can trigger unnecessary further tests, like biopsies, that can create extreme anxiety. And mammograms can find cancers that grow so slowly that they never would be noticed in a woman’s lifetime, resulting in unnecessary treatment."

The interesting thing is the reaction to this new recommendation. The National Cancer Institute will investigate revising its guidelines in light of this report, but the American Cancer Society and the American College of Radiology are both sticking with their previous guidelines of starting screening at age 40.

While some will bristle at the idea of pushing back a cancer screening, looking at the population's overall health and benefits of these screenings is important. Overall, it is more beneficial to delay screening until age 50 unless a woman has an increased risk of breast cancer. It may be hard to stomach for some individuals, but the cost-effectiveness is overwhelming.

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