"Mammogram Recommendations - Why the Conflicting Guidelines"
“For nearly a century, public health organizations,
professional associations, patient advocacy groups,
academics, and clinicians largely viewed cancer screening
as a simple, safe way to save lives.”
But these days, even though we’re all looking
at the same body of evidence,
differing interpretations about the benefits
and harms of mammograms has led
to conflicting recommendations
that range from intensive annual screening
starting at age 40 to no routine screening at all, ever.
Currently, the four main groups in the U.S.
charged with making mammogram recommendations
each set contradictory guidelines;
so, what’s a woman to do?
Well, the guidelines are based
on systematic reviews of the evidence.
In the last 15 years, 50 such reviews have been published,
but they don’t all reach the same conclusions.
The question is: why?
It turns out that the conclusions of systematic reviews
may have been influenced by competing
conflicts of interests of the authors.
Only in health care does “the same group that provides
a service also [tell] us how valuable that service is
and how much of it we need.”
“We must sadly acknowledge that just
as in any other profession or industry,
self-interest is unavoidably at work...”
In an analysis of more than a hundred papers,
the imbalance in those that tended to emphasize
the major benefits of mammography over its major harms
was related to the authors' affiliation.
It may be no coincidence that all the expert panels
that have come out against routine mammograms
excluded radiologists,
figuring those who depend on mammograms for their paycheck
might be more likely to recommend them,
to which mammograms proponents respond:
if you don’t have a conflict of interest,
you’re probably not doing it right,
accusing the breast cancer screening panels
of injecting their own biases.
“In this debate, there are armies of the faithful,
and only a disappointing scattering of moderators and peacemakers.”
Some have even suggested that we shouldn’t
even be talking about this in public,
but “such paternalism assumes that women
cannot decide for themselves,
whether the available evidence supports
or refutes the case for mammography."
Discouraging a discussion with women
about the evidence for and against…
could be considered more harmful for women’s health, not less,
if doctors truly believe that patients should be active partners
in making decisions about their own bodies.
Yeah, if you read the actual studies,
you can see if the investigators
declare any conflicts of interest,
but if you just hear about the studies second-hand,
you may have no idea.
Until the developers of screening guidelines
emphasize evidence over commercial or financial interests,
we all have to take personal responsibility
to become informed consumers.
It would be nice to be able to just trust
like cancer charities, but it's virtually impossible
for such organizations to remain strictly “evidence-based”
when they must rely on keeping donors
happy for their very existence.
To his credit, the Chief Medical Officer of the American Cancer Society
said that we need to be true to the science,
but note this was him talking about prostate cancer screening.
See, the American Cancer Society just straight up
tells women to get mammograms,
but for men, it leaves them to decide for themselves.
They’re open about the prostate cancer screening harms,
but very little transparent information
about the harms of mammograms is provided.
So, there’s this double standard:
women are encouraged to just do it,
while men are advised to weigh the pros and cons,
although the fundamental issues to consider
are actually very similar between the two tests.
The dissimilarity in how organizations like the American Cancer Society
view the patients’ role in decision making
couldn’t be clearer.
Do they believe that men can handle uncertainties
regarding screening tests,
but that women might just get all confused?
Men get to make informed decisions, about their bodies,
but women are merely summoned.
The bottom line is that there is more than one
right answer to the question,
“Should I be screened for breast cancer?”
My goal I have for this video series
is to enable you to make the decision
that is right for you or your loved ones.
One survey suggested that if women were fully informed
at how small the benefit actually was,
70% wouldn’t do it.
But you may be in that 30%
and have a right to decide for yourself.