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Breast Cancer Screening, Revised

December 30, 2013

A friend of mine (at least I hope she’s still my friend) pointed out to me today that the final sentence of this post is misleading at best and potentially dangerous.  She is right.  Herewith, the same post with a different ending…

Gilbert Welch strikes again!  An Op-ed in the NYT today about mammography is a prelude to a study Dr. Welch is publishing this week in JAMA Internal Medicine (another one of those websites where you have to pay to get the actual article).  Here’s the link: http://www.nytimes.com/2013/12/30/opinion/breast-cancer-screenings-what-we-still-dont-know.html?hp&rref=opinion&_r=0

Here is the summary as Dr. Welch writes it:

“Among a thousand 50-year-old American women screened annually for a decade, 3.2 to 0.3 will avoid a breast cancer death, 490 to 670 will have at least one false alarm and 3 to 14 will be overdiagnosed and treated needlessly. That may help some women choose whether to be screened or not. But it’s still not very precise, and it doesn’t answer the fundamental question: Now that treatment is so much better, how much benefit does screening actually provide? What we need is a clinical trial in the current treatment era.”

Large scale trials take 10-15 years, hundreds of thousands of subjects, and quite a bit of money.  But screening and over-diagnosis cost much more.  In 2011, as part of the stimulus package, Congress budgeted some money for what it called “comparative effectiveness” research, the aim of which is to answer questions like that posed by Dr. Welch.  Not a lot of people know that the ACA, or “Obamacare”, that hated law, has actually imposed a tax on private insurance payers for every insuree (if it hasn’t gotten stripped out by republicans yet), the proceeds of which are supposed to go to the Patient-Centered Outcomes Research Institute, a non-profit corporation that essentially functions as a clearing house and coordinator for comparative effectiveness research.   Hopefully some of this money will go towards breast cancer screening research.  Hopefully.

So this is good.  Ha! You never thought you would hear that from me huh?  But I will say that, until the research is done so my daughters can make better choices, I’m going to consider my mammogram options carefully.  I got screened last year.  Maybe I’ll wait a year before I go back.  Maybe not.

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