Sunday, November 22, 2009

Boob News II

I am an unabashed fan of Gina Kolata's health reporting, despite some criticism I've read in the past. Her book on the 1918 flu pandemic was a cliffhanger.
And I am grateful she's dug in on the mammogram issue, because I've been keeping my powder dry until I found a source with some context. That's been hard to do (meaning more than a few minutes with Teh Google.)
So this is recommended.
Tidbit:
...It has been hard for many people, even scientists, to believe that some cancers start then stop or even regress. But researchers all over the world have been finding overdiagnosis in studies of all sorts of cancers.
Dr. Barnett Kramer of the National Institutes of Health, who was not part of the panel, described overdiagnosis as “pure harm” because it means that women are treated with measures like chemotherapy, radiation and surgery for tumors that do not need treating.
...Their analyses concluded that mammograms every two years give the nearly the same benefit as annual ones but confer half the risk of harms.

Is that what you want for your sister, just so you can feel safer? Assuming that you aren't a false positive yourself, of course, in which case you are willing to risk being one of the 1,000 false positives or maybe even all of the above to avoid being one of the  1.5 in 1,000 who needs treatment.
It isn't about  controlling costs with closer scrutiny of screening protocols,  and it certainly isn't about a giant government plot to ration health care to women.
It's about tradeoffs. And it's up to us as medical consumers to recognize our role in the decision making, the supply-and-demand side of it all.
None of us wants to die, but too many of us believe we can avoid death by defying science, the very thing that helps keep us alive. Go figure.

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