The new USPTF guidelines for breast cancer screening have been a super hot topic for the last week. We started out with outrage, moved to outrage at the outrage, and are finally settling into a state of reasonable interpretation. The growing consensus (that I’ve seen) is that the USPTF guidelines are not so far off, but their wording could have been much better. It is true that mammograms before the age of 50 have a low positive predictive value, and thusly a high false positive rate. It is also true, based on the USPTF data, that for every 1000 women screened annually between 40 and 50 years of age, over 50% of them will need additional imaging at one point, 20% will get a breast biopsy, and only 1-2 breast cancer deaths will be prevented. Based on this, it is clearly worth discussing whether patients 40-50 should be getting mammograms.
But the world, at first, didn’t want to discuss it. We immediately attacked the USPTF, even accusing them of somehow being in league with new health care reform policies meant to reduce costs, at the known expense of women’s lives. Even Sanjay Gupta went attack dog against one of the USPTF members live on CNN. That was the most surprising thing to me.
But now people are starting to come around, and they are coming around pretty much to where I started.