Newsweek' "Mammogram Madness" column on breast screening of old women with dementia

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Sharon Begley reports on a study published in the American Journal of Public Health that she says “doesn’t inspire confidence that doctors are following evidence-based practices and putting their patients’ welfare first.” Excerpt:

“In a nutshell: a significant percentage of elderly women with severe dementia are getting screened. Such women have an average life expectancy of only 3.3 years. Yet science-based guidelines from the American Cancer Society and other experts say that women with a life expectancy of less than five years should not be screened (because any cancer that’s found will not grow fast enough to cut into her remaining years). Even more disturbing, if an elderly woman with severe dementia is also married and with a net worth of $100,000 or more, she is more than twice as likely to get these inappropriate mammograms as her poorer peers.”

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Comments (4)

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January 20, 2010 at 3:19 pm

The fact that doctors are not following evidence-based practices isn’t news.
Translation clinical research into medical practice is a huge problem that has been written about by lots of people over many years. Getting physicians to implement even simple, cheap effective practices that are backed by good evidence is often hard. See for example: Lenfant, Claude. 2003. “Shattuck lecture–clinical research to clinical practice–lost in translation?.” The New England Journal of Medicine 349:868-74.
All the recent fuss over the USPSTF Guidelines is all the the more amusing in this context. Most primary docs will tell you that the USPSTF Guidelines are the gold standard but many of them aren’t aware of many of the guidelines issued by the USPSTF or certainly don’t follow them. See for example, work on cervical cancer screening e.g. Sirovich, Brenda E, and H Gilbert Welch. 2004. “Cervical cancer screening among women without a cervix.” JAMA: The Journal of the American Medical Association 291:2990-3.
Here’s their conclusion: “Many US women are undergoing Pap smear screening even though they are not at risk of cervical cancer. The US Preventive Services Task Force recommendations either have not been heard or have been ignored.”

Rose Hoban

January 22, 2010 at 11:10 am

What’s most amazing to me about this article are the comments below it. Based on them, I’d say that clearly, we in the media have NOT done a good job at conveying information about risk, assessing personal risk, and assessing the usefulness or futility of various treatments.
We also haven’t made the point that someone’s gonna have to pay for all that treatment – especially in an atmosphere where people don’t like ‘taxes,’ that they don’t understand that our health care system is full of hidden costs that effectively ARE taxes on the rest of us.