Another Washington Post column that misleads readers on mammography

| 6 Comments

I would ignore this except that it's in the Washington Post and despite the fact that they're closing bureaus in Chicago, Los Angeles and New York, what's in what remains of the paper is still influential.

So I feel compelled to address Dana Milbank's column in the Post about the US Preventive Services Task Force breast cancer screening recommendations.

He characterized the USPSTF recommendations as a "cruel and clumsy blow" that "wiped out much of the progress" in breast cancer detection.

Huh?

It got worse, as he wrote:.

"With a drumbeat of recommendations raising doubts about various cancer screenings, the public could easily get the mistaken impression that all cancer screening is a waste of time and money."

Stop the foolishness.

The USPSTF said nothing about any cancer screening being a waste of time and money. In fact, it recommends biennial screening mammography for women aged 50 to 74 years. It recommended against routine screening mammography in women aged 40 to 49 years, stating "The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms."

How "cruel" to try to ensure that women are fully informed about benefits and harms, and to state that this should be an individual decision based on individual values.

If the public can get the impression that all cancer screening is a waste of time and money from those statements, then Milbank might better spend his time educating the public on how to read.

It got worse. Much worse. As he continued:

"Luckily, Congress has a simpler solution at hand: It can abolish the task force and turn it into a group that is more accountable to the public. Under the House version of health-care legislation, the task force, whose members need not subject themselves or their opinions to public comment or public hearings, would be reorganized as a federal advisory committee subject to oversight. Their scientific judgments would stay independent, but the group would no longer be able to go rogue with surprise recommendations."

Oh, that would be a grand idea. Make science accountable to the public? Let's make science ignore the evidence and tell us fairy tales that we want to hear. That everything is terrific, risk-free and without a price tag? And let's make the independent task force subject to federal government oversight. Then we can make science ignore the evidence and only spew out what is politically popular at the moment.

Milbank believes his ideas mean that the task force would no longer be able to "go rogue with surprise recommendations." Read your own paper, Dana.

Dan Eggen and Rob Stein reported that "The findings underscore a decades-long debate in the medical community about the benefits and risks of routine breast cancer screening for younger women." So this is not "rogue" and not "surprising" to anyone who has made any attempt to follow the issue.

Why did he choose to give only Nancy Brinker's side of the story? His own paper reported this praise for the USPSTF recommendations:

"It's about time," said Fran Visco, president of the National Breast Cancer Coalition, a Washington-based patient advocacy group. "Women deserve the truth -- and the truth is the evidence says this is not always helpful and can be harmful."

But it's really sick when a columnist suggests that task force members be sent to Gitmo and that they be sent "to the Death Panel for a humane end."

If he thought this was humorous, it wasn't. If he thought his column clarified anything, it didn't. Confusion and rhetoric will reign as long as we continue to get one-sided, vacuous, inaccurate columns like this. If, indeed, anyone is reading it.

6 Comments

Agreed. Just Shocking on Milbank's part

I don't disagree with you about the article itself, and I was also put off by the Gitmo/death panel dig, but I'm kind of surprised you took this stance without looking further into the "science" in question. Statistics that lumped (no pun intended) film mammography with digital. Terminology that interchanges "screenings" and "invitations to screen." The age of the data in general. Not to mention that unlucky one in 1900 women whose death is acceptable collateral damage. (A moment of perspective: if one out of 1900 visitors to Disney World's Magic Kingdom was killed this year, there would be about 8,500 bodies stacked up behind Pirates of the Caribbean.)

The numbers also discount the extension of a woman's life while her child makes it from first grade to high school or from middle school to adulthood. Was her death prevented? Statistically, no. But the substance of her life -- and her child's life -- was profoundly changed by early detection and palliative care. It doesn't make sense to discount that when quantifying results, especially when they're attempting to quantify the esoteric "harms" and "anxiety" resulting from breast self-exam.

I didn't love the Post article, but Brinker is right when she says this study should have been a call to action, not inaction: we need to improve screening technology and increase access for low resource women.

His article was wildly unhelpful and I say that as a pre-menopausal breast cancer patient with some very strong opinions about screening. But he does try to point out a gaping hole in this debate, and that's the gap between the epidemiological numbers and individual outcomes. Yes, Virginia, there is a gap. The epidemiology is an important input into public health policy, but it fails to explain why you can walk into any cancer clinic in the US and find: (1) young women whose aggressive cancer was found early by mammography, and (2) young women who are dying of breast cancer a year after their doctor pooh poohed mammography ("you're too young to get breast cancer"). Too many people have met at least one of these women to trust the epidemiology as the final word (let's take a good look at how that data was even reported, for starters), especially when our tools for identifying "high risk" women suck even worse than mammography.

Bottom line: the epidemiological numbers aren't the final answer, and while we're working it out, and searching for a screening tool for the population that has the highest incidence of aggressive breast cancers, it seems only reasonable and humane to give women under 50 a choice. The problem is, once you say "national task force" within earshot of an insurance company, you've likely eliminated the possibility of choice.

This is the way of Washington, D.C. Trash an apolitical group who issued guidelines to serve the public good. Unlike the shrill partisans who want mammograms on demand, the task force has no conflicts of interest. Why not offer and pay for mammograms for women in their 30s, or even younger? Doesn't medical evidence mean anything? Shame on Sebelius. Who would want to serve on the USPSTF? www.MDWhistleblower.blogspot.com

I remember having a similar reaction to the piece MPR (or NPR) did on this story. It left me thinking "that can't be right" since it made it sound like there was no value for mammograms for younger women. That's a dangerous message to tell to higher risk women who may be reluctant to get screened but probably should.

Ed,

Thanks for the comment.

But let me clarify: mammograms in high-risk women are not screening tests.

Screening refers to testing healthy people in the general population who don't appear to have any particular risk.

It's semantics, but it's important. And it's a point that has been twisted and contorted in much of the reaction to the USPSTF recommendations with comments like, "How stupid of them to deny high-risk women these valuable screening tests!" When, indeed and in fact, no one is being denied. And it's misleading to refer to high-risk women as being "screened."

High-risk women are followed up deliberately because of the concern associated with their higher risk.

Screening is like looking at a football stadium filled with unknown people of unknown risk and proceeding like, "Gee, I wonder how many people in this crowd might have something we can find?"

About this Entry

This page contains a single entry by Gary Schwitzer published on November 25, 2009 9:21 AM.

Mammography & the corporate breast: conflicts of interest in critics was the previous entry in this blog.

Reading between the lines of a medical device company's sales & stock results is the next entry in this blog.

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