National Preventive Services Taskforce guidelines debate

The debate about the National Preventive Services Taskforce guidelines continues to heat up. I went to a grand rounds about it yesterday and two interesting comments were made:

The first, from a radiologist, was attempting to address the concerns that we are putting many women aged 39 to 49 years through unneeded biopsies and other diagnostic procedures. This radiologist commented that this was still meaningful because we were diagnosing benign disease that looks like cancer on mammograms. I struggle with understanding how diagnosing anything benign could be helpful to the patient, enough to make the anxiety and difficulties of a biopsy a 'cost negative event. I understand how it is helpful to the mammographer, but if we had never done the mammogram in the first place we wouldn't even need to proceed with the biopsy.

Then, a public health researcher (not a clinician) was commenting on the relative scale of the benefit. He suggested that in counseling patients we tell them that by the time they reach 50 years (if the women do annual mammograms starting at age 39) about half will have had a biopsy for a various number of reasons, and that when pooled, the average risk a woman benefits overall by a fews days additional life expectancy. This is largely because we are so good at curing breast cancer that, relative to the incidence, not that many people die from breast cancer. This also means the number of women in their 40s needed to invite to screening to save one life from breast cancer is around 1,900. This still seems like an awful lot to me!

I am beginning to understand that these guidelines are suggesting a conversation around mammograms in their 40s and not forbidding them and could have been more clearly worded to that effect. However, I still find this debate around the relative benefits of mammography to be very interesting and important and if nothing else, this report opened that door for this discussion.