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Now what do I do? Suddenly women in their 40s must ponder whose mammography advice to follow
November 17, 2009
This story had one major flaw – suggesting that this was about withholding needed care – a misguided suggestion that overshadowed the task force’s call for improved shared decision-making.
Our Review Summary
News of the new recommendations from the US Preventative Services Task Force (USPSTF) stating that average risk women need not start regular mammography screening until age 50 has exploded all over the media. The timing of the issuing of the new guidelines at the time of great debate in health care reform has many women wondering if this is an attempt by the government to contain costs or somehow deny preventative services. In fact, the new statement by the USPSTF is not actually new. There are no new data or studies that have been published recently that provided the impetus for the new recommendations. Rather, this is a culmination of years of research and taking a bold new look at our familiar mantra that early detection is better. We all like to believe we have control, but truth is that we have been oversold on the benefits of mammography.
The new recommendations will not deny mammograms to women who want them, women in their 40's will still be able to get screened and insurance companies have emphasized that they will still be covered. Women who are at high risk, such as those with a family history or African-American women, who tend to get more aggressive forms of breast cancer, will still get offered regular screening. But for those women at average risk, the new guidelines state that it is reasonable to wait to start screening until age 50.
This story does a good job of describing the potential harms of mammography screening, including needless procedures and stress and anxiety from false positive results. The story quotes multiple sources who provide valuable contrasting perspectives.
The story could have been improved by describing the costs or insurance coverage for mammograms and if or how this recommendation might affect insurance coverage. Nor does the story discuss the evidence for the new recommendations. Readers would want to know if this is based on new results or just a new look at the same studies. Finally, the story does not adequately quantify the benefits or harms of mammography. The representative of the American Cancer Society provides the number needed to screen, which is very helpful, but this should have come from a source that is more objective. A reader might also want to know the false-positive rate for mammography.
The story seems to suggest that the recommendation was to not have screening without presenting the second part of the recommendation - that “The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms.” The framing that this is about withholding needed care seems misguided.
In the end, the new recommendations emphasize that deciding when to start screening is a DECISION that women can make on their own, in consultation with their doctors. One good thing that may come out of the confusion is that women will more openly discuss the pros and cons of screening with their doctors.
Click on Criteria for definitions.
Clearly mammograms are widely available.
There is no mention of costs or insurance coverage for mammograms and if or how this recommendation might affect insurance coverage.
The story does not exaggerate the seriousness or prevalence of breast cancer.
The story does not discuss the evidence for the new recommendations. Readers would want to know if this is based on new results or just a new look at the same studies.
The story adequately describes the harms of mammograms, such as needless procedures and stress and anxiety from false positive results.
Clearly mammograms are not a new idea, but delaying starting screening until age 50 is a relatively new concept in the US. The story could have explained, though, that this idea is not at all novel in other Western countries.
The story does not adequately quantify the benefits or harms of mammography. The representative of the American Cancer Society provides the number needed to screen, which is very helpful, but this should have come from a source that is more objective. A reader might also want to know the false-positive rate for mammography.
Because the story quotes multiple sources, the reader can assume the story does not rely on a press release as the sole source of information.
The story quotes multiple experts who provide contrasting view points and much needed perspective. It should be noted though, that, in terms of pure quote count, those who oppose the new recommendations outnumber those voices who support them.
The story mentions breast self-exams, breast exams by a clinician and no screening as alternatives to regular mammography screening.
Total Score: 7 of 10 Satisfactory
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