Gregoire "As Frustrated as I Could Be" With Mammogram Advice

I found the Slog’s citation of the report to be pretty informative:

The cumulative risk for false-positive mammography results has been reported as 21% to 49% after 10 mammography examinations for women in general (39—41), and up to 56% for women aged 40 to 49 years.

So, half of women aged 40-49 who receive annual mammograms have false positives.

Moving away from mammograms and realizing there is serious work left to do on the cancer front is a medical advance, not a medical retreat, as frustrating as it is. We can form the exact conclusion from prostate, colon, and cervix cancer screening recommendations. According to the research, cancer screening is not effective for vast sections of the populations we have historically been routinely screening.

I found the Slog’s citation of the report to be pretty informative:

The cumulative risk for false-positive mammography results has been reported as 21% to 49% after 10 mammography examinations for women in general (39—41), and up to 56% for women aged 40 to 49 years.

So, half of women aged 40-49 who receive annual mammograms have false positives.

Moving away from mammograms and realizing there is serious work left to do on the cancer front is a medical advance, not a medical retreat, as frustrating as it is. We can form the exact conclusion from prostate, colon, and cervix cancer screening recommendations. According to the research, cancer screening is not effective for vast sections of the populations we have historically been routinely screening.

Welcome to the future world of Obamacare, Governor! You voted for him, I am afraid you must live with the consequences. Suspect you voted for Patty and Maria as well who are supporting the Obamacare health plan.

I have my own personal doctor who stays at my place and runs tests daily. That way I’ll know ahead of time on any health care issue I get. I am living proof that this is the best way to do thing.

I have my own personal doctor who stays at my place and runs tests daily. That way I’ll know ahead of time on any health care issue I get. I am living proof that this is the best way to do thing.

@2 Mike…you are aware that Kathleen Sebelius, Obama’s Secretary of Health and Human Services, rejected the new recommendations, right? Or, do facts get in the way of your rant?

@2 Mike…you are aware that Kathleen Sebelius, Obama’s Secretary of Health and Human Services, rejected the new recommendations, right? Or, do facts get in the way of your rant?

Gregoire’s personal anecdote may be touching, but it’s irrelevant to the current discussion. She was 55 when diagnosed with breast cancer.

Gregoire’s personal anecdote may be touching, but it’s irrelevant to the current discussion. She was 55 when diagnosed with breast cancer.

Come on Gregoire, unless you have a degree in medicine, or have at least spent some time reading studies on the benefits and risks of early screening you really should not be commenting.

If early screening were risk free then yeah screen everybody, but its not. How about we let doctors and people who have the time and knowledge to study this do their thing and then we all can talk with our doctors, in light of the evidence, and decide what we need to be screened for (which by the way this study advocated. It was not mammograms, just not making them automatic).

Come on Gregoire, unless you have a degree in medicine, or have at least spent some time reading studies on the benefits and risks of early screening you really should not be commenting.

If early screening were risk free then yeah screen everybody, but its not. How about we let doctors and people who have the time and knowledge to study this do their thing and then we all can talk with our doctors, in light of the evidence, and decide what we need to be screened for (which by the way this study advocated. It was not mammograms, just not making them automatic).

The attack by doctors on cancer screening — first PSA, then mammograms, then pap smears — drives me nuts. It’s also a teaching moment in that people who actually pay attention can learn that while the running of a clinical trial is mostly science, the *interpretation* is still an art. I’ll speak about prostate cancer (PCa) because it is the area I know most about. The lessons are applicable to mammograms and pap smears, too.

I’ve been attending every major prostate cancer and oncology scientific conference since 2003 (took a break in 2009). Around 2005, a group of new leaders in the PCa medical community started pushing an agenda against “overtreatment” of prostate cancer. They are correct in their assertions we treat many PCas that don’t need treatment — cancers that would be better served by watchful waiting.

Their arguments really didn’t get anywhere. Their vocal opponents claimed their patients did not want to listen and demanded treatment. Less vocal opponents (usually the type who rarely show at medical conferences) did some math and determined treating fewer patients would be bad for their practices’ finances.

In 2007, a specialized PCa conference featured the first serious debate on screening. I sat in stunned silence as leading doctors in the field argued against early detection of cancer. Their reason? Not that it would improve mortality rates for cancer, but that it would reduce “unnecessary” treatments.

The biggest lie put forward here is that screening is bad for patients. There is no meaningful morbidity or mortality connected with the act of screening itself. What problem there is connects to overtreatment — either by overzealous physicians (50% of the problem) or patients who make their own personal healthcare decision and want [insert appropriate body part here] cut out because they don’t want to take even a statistically small risk the cancer might spread.

Otherwise well-meaning people like @1 above throw the false positive statistic around, but it is meaningless. No doctor performs significant therapy without far more tests than the initial screen – for PCa that’s a prostate biopsy and often sophisticated radiology scans. While there is some discomfort and short-term side effects from biopsies, they are not a significant source of morbidity and mortality either.

The new PCa recommendations are particularly bad because they recommend ceasing PSA tests above a certain age with no regard for family history of longevity. They assume men of a certain age should not receive treatment, so they should remain ignorant of their disease. A man at age 70 in good health with appropriate family history can live another 15 years easily, meaning statistically a missed diagnosis of even non-aggressive PCa due to lack of screening will cause his life to end prematurely from PCa.

Earlier this year, the American Urology Association (AUA) made some amends in my eyes by extending the screening recommendation to 40 years from 50 years. For me, this would have prevented a 30-minute discussion with my PCP (oops, sorry, Primary Care Physician) at age 40 about getting a PSA/DRE test (I won). Good conversation, though, and one that brought my doctor and I to a better relationship.

There is value in reducing overtreatment. The only way this happens is better patient education to spur better conversations between doctor and patient. The way this DOESN’T happen is reducing screening.

“Baby with the bathwater” comes to mind, but this time we’re playing with peoples’ lives. The leaders of the medical groups adopting these recommendations should be ashamed.

Over the next 12 months, I’ll be attending another dozen medical conferences — many of them oncology conferences. It will be interesting to see if rank-and-file doctors start pushing back publicly.

For the sake of their patients, I hope so.

The attack by doctors on cancer screening — first PSA, then mammograms, then pap smears — drives me nuts. It’s also a teaching moment in that people who actually pay attention can learn that while the running of a clinical trial is mostly science, the *interpretation* is still an art. I’ll speak about prostate cancer (PCa) because it is the area I know most about. The lessons are applicable to mammograms and pap smears, too.

I’ve been attending every major prostate cancer and oncology scientific conference since 2003 (took a break in 2009). Around 2005, a group of new leaders in the PCa medical community started pushing an agenda against “overtreatment” of prostate cancer. They are correct in their assertions we treat many PCas that don’t need treatment — cancers that would be better served by watchful waiting.

Their arguments really didn’t get anywhere. Their vocal opponents claimed their patients did not want to listen and demanded treatment. Less vocal opponents (usually the type who rarely show at medical conferences) did some math and determined treating fewer patients would be bad for their practices’ finances.

In 2007, a specialized PCa conference featured the first serious debate on screening. I sat in stunned silence as leading doctors in the field argued against early detection of cancer. Their reason? Not that it would improve mortality rates for cancer, but that it would reduce “unnecessary” treatments.

The biggest lie put forward here is that screening is bad for patients. There is no meaningful morbidity or mortality connected with the act of screening itself. What problem there is connects to overtreatment — either by overzealous physicians (50% of the problem) or patients who make their own personal healthcare decision and want [insert appropriate body part here] cut out because they don’t want to take even a statistically small risk the cancer might spread.

Otherwise well-meaning people like @1 above throw the false positive statistic around, but it is meaningless. No doctor performs significant therapy without far more tests than the initial screen – for PCa that’s a prostate biopsy and often sophisticated radiology scans. While there is some discomfort and short-term side effects from biopsies, they are not a significant source of morbidity and mortality either.

The new PCa recommendations are particularly bad because they recommend ceasing PSA tests above a certain age with no regard for family history of longevity. They assume men of a certain age should not receive treatment, so they should remain ignorant of their disease. A man at age 70 in good health with appropriate family history can live another 15 years easily, meaning statistically a missed diagnosis of even non-aggressive PCa due to lack of screening will cause his life to end prematurely from PCa.

Earlier this year, the American Urology Association (AUA) made some amends in my eyes by extending the screening recommendation to 40 years from 50 years. For me, this would have prevented a 30-minute discussion with my PCP (oops, sorry, Primary Care Physician) at age 40 about getting a PSA/DRE test (I won). Good conversation, though, and one that brought my doctor and I to a better relationship.

There is value in reducing overtreatment. The only way this happens is better patient education to spur better conversations between doctor and patient. The way this DOESN’T happen is reducing screening.

“Baby with the bathwater” comes to mind, but this time we’re playing with peoples’ lives. The leaders of the medical groups adopting these recommendations should be ashamed.

Over the next 12 months, I’ll be attending another dozen medical conferences — many of them oncology conferences. It will be interesting to see if rank-and-file doctors start pushing back publicly.

For the sake of their patients, I hope so.

Welcome to the future world of Obamacare, Governor! You voted for him, I am afraid you must live with the consequences. Suspect you voted for Patty and Maria as well who are supporting the Obamacare health plan.