Friday, November 27, 2009

The Prudent Use of Medical Screening Tests by Denise Zito

Everyone has probably heard the story of the 1950’s x-ray machines used by stores to measure your shoe size. I wasn’t there but I heard you could stand on these and see your foot bones as well as learn your shoe size. They were especially used to measure children’s feet and were considered technology at its best. Eventually, someone pointed out that maybe it wasn’t healthy to use an x-ray machine to measure your foot-- there were safer ways to figure out what size Striderite your toddler needed.

The latest outcry over healthcare reform involves the revised guidelines for mammography. The U.S. Preventive Services Task Force, made up of independent experts in primary care and prevention, systematically reviews the evidence of effectiveness and develops recommendations for clinical preventive services. This group is a branch of the Agency for Healthcare Quality, a highly respected advisory group. If you look at their website, you’ll see a long list of recommendations in favor of some screening procedures and recommending against others. For example, the agency recommends against routine chest x-rays to detect lung cancer because there is no evidence that we would save more lives by doing this. However, they do recommend screening for prostate cancer in elderly men.
This Task force has reviewed breast cancer data and is now recommending that women in their 40s not undergo routine mammograms, and instead individually discuss with their doctors whether to have the exams. It recommends that routine mammograms begin at age 50.
Critics are saying that the revision of the guidelines is a form of rationing.
In fact the reason for the change is well-founded in fact and science. Though the task force is emphasizing the number of false positive mammograms, what many people seem to forget is that a mammogram is an x-ray and an x-ray carries its own set of risks and should be used prudently. Every x-ray or mammogram received carries a small risk of inducing cancer. And no one knows which woman is sensitive to the radiation and can actually be damaged by the x-ray, instead of benefiting from it by detecting an early cancer.

The U.S. has for years been encouraging women to begin yearly mammogram screening at age 40, while Europe begins at age 50 and screens every other year. The Task Force has looked at the data and determined that it’s not worth the associated risk and unproductive follow-up procedures, and the unnecessary exposure to radiation for the benefit of a few more early breast cancer detections. And, we’re not certain that early detection of all cancers leads to a better outcome.

If you’re a woman whose cancer was detected by early mammogram, you’ve got a right to be upset by this recommendation. But the rest of us should stop and ask ourselves—‘what if I’m a woman who is sensitive to radiation and might actually be increasing my risk of cancer by having a yearly extra x-ray.’ We worry a lot about the former and forget about the latter situation.

Now I’m not suggesting that a mammogram is as dangerous as the shoe-fitting x-ray machine, I’m only saying that prudence and hard science should dictate health policy and that revising guidelines to give women less radiation exposure over their lifetime, is probably a very good thing.


  1. This is the most intelligent thing I've heard on this issue, which has attracted a lot of irrational comments. Everyone who's concerned about the question would profit from hearing or reading Denise Zito's balanced analysis of what's at stake.
    George Thomas, Charlottesville

  2. Ms. Zito's careful analysis on the wisdom of the revised guidelines for mammograms should be on the front page of every newspaper in the country and on every news organization's website. If we are to rein in healthcare costs in this country, this is the type of information that is essential to make effective and reasonable decisions. Well said!



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