This is the kind of journalistic explanation of the breast cancer issue that we need

Slate republishes a five-year old piece that does two things:

• a good job of explaining the potential harms of screening
• re-establishes the fact that this is NOT a new debate (by the very fact that it’s 5 years old and could have just as easily been 15 years old).

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November 18, 2009 at 1:05 pm

I just watched a CNN bit with Dr. Gupta and a spokeswoman for the gov’t group that recommended the change from age 40 to 50 for mammograms. She was basically made to defend a position (that Dr. Gupta asserted as fact) that she thinks increased deaths due to reduced screening are okay. It was a pretty crappy tactic.
Thanks for the Slate article. It has some great points that I wish more people were aware of – including Dr. Gupta. It’s a shame that a physician would use his credibility to bolster the tactics of hit-and-run media, but that’s about what this amounts to.
Incidentally, I was curious about the rate of incidence of breast cancer by age. has some data which indicates that 0.4% of women will develop breast cancer by age 30, about 1.4% by age 40, and about 2.4% by age 50. So there is about a 1% increase in absolute terms for every decade from 30-50. It’s amazing to me that 1% causes such a fuss from age 40 to age 50, yet the same difference (in absolute terms) exists up to age 40 from age 30. Why not start testing at 30? My point being that there is a threshold expense-to-risk level that the public accepts. Period. As a society we do not think that all tests should be performed on all people all of the time. And as the Slate article points out, testing does not come without costs. It is imperfect and can cause anxiety with false positives, treatment for cancers that will never progress, and can even cause new medical problems as a result of the treatment itself.
I hope physicians-that-are-also-journalists start realizing that by (ab)using their positions of trust as doctors to lend credibility to hit-and-run stories, they cheapen both medicine and journalism.
Thanks for the blog.


November 19, 2009 at 10:29 am

Yes, thanks for this blog.
I want to add a note on women who develop breast cancer early both because of the figures cited above and because women who developed breast cancer at at early age have been brought out by the media to trash the current recommendations.
The recommendation regarding screening between 40 and 50 is not for all women. I quote from the recommendations: “This recommendation statement applies to women 40 years or older who are not at increased risk for breast cancer by virtue of a known underlying genetic mutation or a history of chest radiation.”
If you go back a few years you’ll discover the USPSTF issued recommendations on BRAC1/2 testing. These are worth reading. If a woman has an increased risk based on family history (e.g. you have a family member with a BRCA mutation, family member dxed with breast cancer at an early age, incidences in the family of bilateral breast cancer, family history of both breast and ovarian cancer, any history involving male breast cancer, etc.) she should be talking to her primary doctor. If there is suspicion that the family history indicates inherited risk then she should be offered a referral to a specialist who deals with these issues, someone who will do a proper risk assessment, discuss the risk, and who can lay out all the options for high risk patients and their various pros and cons. Be aware that your primary doc may be a bit clueless on these matters but a primary doc should be able to recognize potentially higher risk patients and should be referring them. Patients eventually determined to have an inherited risk should be considering more options than just “should I start mammography at 40?” or “should I be doing mammography annually?”