Wednesday, November 23, 2011

i don't understand

The Canadian Task Force on Preventative Health Care has released new guidelines for breast cancer screening. Among other things they have recommended that women under the age of 50 with an "average risk of breast cancer" not be referred for regular mammograms. Women over 50 would only get mammograms every 2-3 years (as opposed to every year). They also advise against regular breast exams and self-examination.

I don't understand.

On their web site, the Task Force gives no reasons for these guideline changes but I have heard several interviews on the radio and the main arguments seem to be that mammograms generate too many false positives, submitting many women to uneccessary biopsies and other intervention. 

There must be more to this. I have to be missing something. I have witnessed the trauma and fear that false postives inflict on the women and their families who live through it. However, I don't think it's as bad as the trauma of being diagnosed at Stage 4 because breast cancer was not caught at an earlier stage. And breast cancer in younger women, is often more aggressive.

Is there a part of this story that I'm missing? Task Force spokespeople insist that the new guidelines were not influenced by the desire to conserve resources. Really? Colour me skeptical.

The Canadian Breast Cancer Foundation released a statement yesterday in support of regular mammography and critical of the new Task Force guidelines:

“The fact is scientific evidence demonstrates that earlier detection and diagnosis can save lives among women 40-49 by at least 25%,” said Sandra Palmaro, CEO, Canadian Breast Cancer Foundation – Ontario Region.

Palmaro added that screening can help find cancers that are smaller and haven’t spread, which can allow for better treatment options and reduced disability and death from breast cancer. Breast cancer continues to be the most frequently diagnosed cancer among Canadian women.
 One of CBCF’s most significant concerns about the Task Force report is that it relied heavily on old data from “randomized controlled trials” (RCT’s) related to breast cancer screening and mammography, some of which are 25 – 40 years old and were based on equipment that is now outdated. There has been an enormous change in breast imaging since that time, including significant improvements to analog technology, and the continued adoption of digital mammography across Canada. Digital mammography has been shown to increase accuracy in younger women pre and perimenopausal women, and women with dense breasts, the group the Task Force recommends be excluded.
This sounds pretty convincing to me. Your thoughts?


Anonymous said...

Hi Laurie,
Beautifully written.I have send a letter to Globe and Mail today.I wonder if they will publish it? One of the Calgary radiologists Dr.Kruger wrote a letter as well. Have not seen more...Hopefully more of us will do it.I would rather deal with the false positive results of the mammogram and possible biopsy ,than stage 4 diagnosis.

Anonymous said...

This was a major issue in the U.S. in the last year or so. The science behind it is very confusing. Depending upon what I read, I go back and forth on the issue.

Beth L. Gainer said...

Ridiculous. The US had a similar "controversy." I really hope science improves and, like you, I would rather have a false positive than Stage IV that wasn't detected earlier.

Lene Andersen said...

this is insane. Aside from the personal perspective that I'd much rather experience a false positive than a late diagnosis, basing recommendations on studies that are from the Stone Age in terms of technology and approach to health care is just... Well, it's bad science. If this is some kind of smokescreen to save money, I'm not sure it does - won't it cost more to treat the people who have a late diagnosis than the false positives?

It's irresponsible healthcare as far as I'm concerned.

Anonymous said...

There is more in Globe and Mail today by Andree Picard. I have e-mailed him a link to your blog. Hope you do not mind? My letter is in today's paper as well.

laurie said...

This is why I write about this - to know that there are like-minded people out there. Thanks to you all. And K- congrats on your letter! Thanks for forwarding my link. Now I wish I hadn't cancelled my Globe. I'll see what I can find online.

Anonymous said...

I hope you can find an article.I do not want to make any more comments. I have expressed my disappointment in my direct e-mail.
It is Andree Picard"When it comes to breast cancer science trumps wistful thinking"It is on front page of the today's Globe and Mail.(Nov.24th)