Rochester freelancer criticizes Mayo stance on mammography

Paul Scott has an opinion piece in the Rochester Post-Bulletin in which he criticizes what he calls the Mayo Clinic’s “vague and surprisingly unprepared” response to the US Preventive Services Task Force’s mammography recommendations.

“Taking unspecified issue with “the modeling data used in the analysis,” it stated “a substantial number of women who receive biopsies because of a screening mammogram are found to have cancer.” Mayo’s Dr. Sandhya Pruthi added “there are many stories about younger women who have found cancer early as a result of screening.”

I’m not sure why she made mention of stories. Dr. Pruthi is surely a talented clinician, but in supporting mammograms for women in their 40s here she is citing anecdotes, not data. It would have been better for her to acknowledge that when it comes to population-wide recommendations about screening and illness, medicine always eventually draws a line in the sand somewhere. People invariably will fall on either side of that line wrongly, but if we don’t draw a line somewhere, you have to screen everybody for everything, and screening sets in motion the potential for new harms.”

It seems that anyone who opposes the USPSTF recommendations trots out personal anecdotes to bolster their argument. Scott countered and concluded with an anecdote of his own:

“I would like nothing more than for our society to prevent the incidence of breast cancer. It took the life of my mom, who identified a tumor on her own at 37, was treated surgically at Mayo in the mid 1970s, and who then lived another 26 years. But my mom believed in science, and in trusting science, and in this case, the science says what it says. I hope that Mayo can do the same, even when doing so runs against that which is popular.”

The first online comment posted in response to Scott’s opinion piece stated that “there isn’t one single oncologist on the US Preventive Services Task Force.” I’ve heard that curious argument before. Evidence is evidence – regardless of whether you’re a primary care doc, an oncologist, an epidemiologist, an ob-gyn or a breast surgeon. Evidence-based medicine should be guided by the best evidence, not by the personal experiences or preferences of any specialty group.

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November 23, 2009 at 11:57 am

“I’ve heard that curious argument before. Evidence is evidence – regardless of whether you’re a primary care doc, an oncologist, an epidemiologist, an ob-gyn or a breast surgeon.”
True, but 95% of the American public are impervious to evidence and reasoned argument. Don’t be surprised if we get the health care we deserve.


November 23, 2009 at 11:37 pm

Well, I think the real reason basically every reputable, high quality medical organization has not accepted this will soon be revealed. There are questions about the data used and the factor of effective treatments used since 2007 (when data was collected) This data and understanding of cancers and their specific treatments impacts life expectancy. The non-oncology docs or non-specialists from cancer field doing the review didn’t understand and/or failed to factor in these things. In addition, there are recent studies from Sweden, I believe, that were meticulous in data collection and methodology that show results using 100,000 women over 20+ years of mammography screening. The examples from Mayo of real women show the reality of the numbers and the failings of allowing statistics to guide us in saying lives are no longer worth it. I’m glad our doctors see us as people not just stats and speak up with passion when we are faced with outrageous recommendations.

Gary Schwitzer

November 24, 2009 at 8:35 am

I’m not sure you know who’s on the USPSTF, so I’ve posted their names here since you state that “the non-oncology docs or non-specialists from cancer field doing the review didn’t understand and/or failed to factor in” some unspecified information.
Before you accuse this independent group – with admirably wide-ranging perspectives and expertise – of not knowing how to evaluate evidence adequately, maybe you should reflect on who they are, what they’ve done in their lives, and what value can come from independent review
Bruce N. Calonge, M.D., M.P.H. (Chair)
Chief Medical Officer and State Epidemiologist
Colorado Department of Public Health and Environment, Denver, CO
Diana B. Petitti, M.D., M.P.H. (Vice Chair)
Professor of Biomedical Informatics
Fulton School of Engineering
Arizona State University, Tempe, AZ
Susan Curry, Ph.D.
Dean, College of Public Health
Distinguished Professor
University of Iowa, Iowa City, IA
Allen J. Dietrich, M.D.
Professor, Community and Family Medicine
Dartmouth Medical School, Hanover, NH
Thomas G. DeWitt, M.D.
Carl Weihl Professor of Pediatrics
Director of the Division of General and Community Pediatrics
Department of Pediatrics, Children’s Hospital Medical Center, Cincinnati, OH
Kimberly D. Gregory, M.D., M.P.H.
Director, Maternal-Fetal Medicine and Women’s Health Services Research
Cedars-Sinai Medical Center, Los Angeles, CA
David Grossman, M.D., M.P.H.
Medical Director, Preventive Care and Senior Investigator, Center for Health Studies, Group Health Cooperative
Professor of Health Services and Adjunct Professor of Pediatrics
University of Washington, Seattle, WA
George Isham, M.D., M.S.
Medical Director and Chief Health Officer
HealthPartners, Minneapolis, MN
Michael L. LeFevre, M.D., M.S.P.H.
Professor, Department of Family and Community Medicine
University of Missouri School of Medicine, Columbia, MO
Rosanne Leipzig, M.D., Ph.D
Professor, Geriatrics and Adult Development, Medicine, Health Policy
Mount Sinai School of Medicine, New York, NY
Lucy N. Marion, Ph.D., R.N.
Dean and Professor, School of Nursing
Medical College of Georgia, Augusta, GA
Joy Melnikow, M.D., M.P.H.
Professor, Department of Family and Community Medicine
Associate Director, Center for Healthcare Policy and Research
University of California Davis, Sacramento, CA
Bernadette Melnyk, Ph.D., R.N., C.P.N.P./N.P.P.
Dean and Distinguished Foundation Professor in Nursing
College of Nursing & Healthcare Innovation
Arizona State University, Phoenix, AZ
Wanda Nicholson, M.D., M.P.H., M.B.A.
Associate Professor
Johns Hopkins School of Medicine and Bloomberg School of Public Health, Baltimore, MD
J. Sanford (Sandy) Schwartz, M.D.
Leon Hess Professor of Medicine, Health Management, and Economics
University of Pennsylvania School of Medicine and Wharton School, Philadelphia, PA
Timothy Wilt, M.D., M.P.H.
Professor, Department of Medicine, Minneapolis VA Medical Center
University of Minnesota, Minneapolis, MN


November 26, 2009 at 8:44 am

Keep in mind the VA has always recommended mammography every 2 years for women age 50 and over. I don’t know if you consider VA “highly reputable”…I suppose that is debatable…but they have been consistent in looking only at objective evidence. And now they don’t have to change gears at all.