More Writing On and Coverage of the Mammography Controversy
I’ve been reading a lot and paying attention to other media this week on the U.S. Preventive Services Task Force’s recommendations on breast cancer screening. The following are some pieces that I thought were well-done and/or raised interesting points:
Three posts by Orac of Respectful Insolence at ScienceBlogs –
1) Really rethinking breast cancer screening; 2) “Obama’s fixin’ death panels for your mama,” the misogyny gambit, and other idiotic responses to the updated USPSTF mammography recommendations; 3) “Obama’s fixin’ death panels for your mama”: The USPSTF recommendations for mammography used as a political weapon. I’m not in love with some of the post titles, but Orac nicely covers some of the controversial aspects; also good discussion in the comments of all three posts.
The Balance of Screening Tests by Mark Chu-Carroll of Good Math, Bad Math at ScienceBlogs. A bit about the mathematical considerations of screening.
Between the various ScienceBlogs posts there is some good discussion of the problem of finding an optimal cut-off point for screening.
Mammography News: You Heard It Here First … and It’s Still an Outrage! from the National Women’s Health Network, on how it’s actually been known for a while that current screening (mammography) is not so effective for younger women, but nothing much has changed since that started to become known. Short version: be angry screening tech hasn’t gotten better in response to the evidence, not angry about the evidence itself.
Does Mammography Screening Save Lives? Let’s Talk About It from Breast Cancer Action. Argues that the messaging about breast cancer and early detection has been oversimplified for far too long. Provides a decent summary of the recommendations and risks.
New Mammogram Recommendations Patronize Women from Feminist Law Professors. Makes the argument that the “anxiety” of a mammogram is not so much and the new recommendations are kind of “don’t worry your pretty little head” patronizing of women. I have to disagree, but I could see why people think the recommendations are focused that way, based on the media coverage. Psychosocial harms *are* mentioned in the actual recommendations, but what seems to be missing in coverage of “anxiety” as a basis for the recs are the other harms described in the original report such as radiation exposure, invasive biopsies, cost, unnecessary treatment, and the like. If the reason not to routinely do screening mammography for women 40-49 of average risk was actually given as just potential anxiety (ignoring the real functional problem anxiety can be for many people), then yes, that would be completely patronizing and innapropriate. That’s not how I read the recs at all.
I have seen a number of posts and pieces and comments asking a legitimate question – what about black women? For example: Dear USPSTF: What About Mammograms for Black Women? by Nordette Adams at Whose Shoes are These Anyway? We know – although white women are more likely to get breast cancer – that black women are more likely to die of breast cancer, more likely to have it at a younger age, more likely to have a more advanced cancer when diagnosed. To me, this would make black women not in the “average risk” group the USPSTF recommendations say can make individualized decisions about mammography instead of doing routine screening starting at age 40, which I didn’t hear any news stories explicitly point out. The USPSTF documents for the recommendations actually note as a limitation that the models they used do not “capture differences in outcomes among certain risk subgroups, such as women with BRCA1 or BRCA2 genetic susceptibility mutations, women who are healthier or sicker than average, or black women who seem to have more disease at younger ages than white women” but I’d be surprised if anybody heard mention of that in the media coverage of the recommendations.
Statement from the National Cancer Institute. “The take-away message is that each woman needs to consider her individual benefits and risks and discuss them with her health care provider before making a decision on when to start screening mammography and how often to get one.” The national cancer agency also says it’s “too early” for them to make any decisions related to the recommendations.
Making Sense of New Mammography Recommendations – from the Komen folks. I’m not a huge Komen fan, but they take a pretty balanced approach.
American Cancer Society Responds to Changes to USPSTF Mammography Guidelines. Short version: we’re not changing our position right now. Neither is the cancer center at my larger workplace, apparently.
NPR had a ton of stories on the topic. Seriously. That link is to a search and there currently about 3 pages of results linking to various stories and aspects of the news.