Challenging Breast Cancer Axioms Too Often Hyped By Emotion

American women face conflicting advice about whether to be screened for breast cancer, at what age and how often. The decisions they make are often more strongly influenced by fear or a friend’s experience than by a thorough understanding of the benefits and risks of mammography, as described in this personal health column appearing in The New York Times:

In 2009, the United States Preventive Services Task Force recommended that women 50 to 74 be screened with mammography every two years and that biennial screening of women younger than 50 be considered case by case. There is no good evidence on whether women older than 75 should be screened, the task force said.

Yet, screening rates have not declined. Under the Affordable Care Act, free screening mammography is available to all women every one to two years.

Despite the task force guideline, the American Cancer Society, the American College of Radiology and the Society of Breast Imaging continue to recommend yearly mammograms starting at 40 for women at average risk for breast cancer.

Dr. Lisa Rosenbaum, a national correspondent for The New England Journal of Medicine, says the seemly contradictory responses are part of “the tangled nature of emotions and values” that practitioners and women bring to mammography.

Clinicians often struggle to balance their responsibility to base recommendations on evidence with their respect for what patients want.

“Defaulting to patient preference in the face of uncertainty has become the moral high ground,” Dr. Rosenbaum wrote. “But it is as much our job to figure out how to best help our patients lead healthier lives as it is to honor their preferences.”

To which breast cancer expert Dr. Jay Harness adds:

“It is the job of patients to at least consider the risks and rewards before deciding to be screened for breast cancer, and it is the job of breast cancer practitioners to help their patients gain information strength to make good decisions.”

Read the full story here.

[Illustration Credit: Scott Bakal, Source: The New York Times]

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