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Minnesotans speak up in support of new breast screening recommendations. But are they being heard?

In recent days, a few local voices of reason have managed to rise (faintly) above the din of fear-mongering that has dominated media reports on the new breast cancer screening recommendations issued last week by the U.S. Preventive Services Task Force (USPSTF).

Dr. Timothy Wilt, professor of medicine at the University of Minnesota and a member of the task force, was featured in Maura Lerner’s very reasoned article about the controversy in the Strib last Friday. (Full disclosure: Maura is a long-time friend of mine.)

I spoke with Wilt myself last week on the phone, soon after the firestorm about the task force’s recommendations erupted. He seemed a bit stunned about the reaction, particularly the charge that the task force was somehow dictating to women when and how often they should have mammograms — specifically that women under the age of 50 should not be screened.

“We never said that. It’s not in our recommendations. It’s a false statement,” he said.

“Our recommendations state,” he added, “that routine screening mammography in women aged 40 to 49 should be an individual decision” — but a decision based on a “factual” risk-benefit analysis that takes into account the harms as well as the benefits of screening.

“In the past, those harms have not been accurately communicated,” he said.

Anecdotal science?
Also featured in the Strib article was Christine Norton, a breast-cancer survivor and co-founder of the Minnesota Breast Cancer Coalition, who has watched in frustration as the task force’s recommendations were pilloried in much of the press.

“Those of us across the country who support the recommendations are so frustrated by the anecdotal stories and screams of [health care] rationing,” she wrote to me in an e-mail Monday.  “It reached a point last week where I even turned off [Minnesota Public Radio newscaster] Gary Eichten’s show because I just couldn’t stand another person spouting an anecdote and believing that anecdote should become a public policy recommendation.”

Et tu, Mayo?
On Monday, Paul Scott, a freelance writer based in Rochester, Minn., (and who wrote this Second Opinion blog while I was on vacation last fall) took the Mayo Clinic to task in the Rochester Post-Bulletin for rejecting the task force’s evidence-based guidelines.

“Mayo is hardly the only organization reluctant to stand behind this unpopular but objective science on breast cancer screening,” wrote Scott. “But in my view, it is surely one of the parties with the most to lose. If the Clinic will not respect this finding about mammograms, it makes it that much harder for it to take the high road when less competent health centers ask to be paid for tests and treatments that do not meet the test of science.”

What have we learned?
As I noted last week, the confusion, anger, and outright distortions of the facts surrounding the release of the task force’s recommendations have been nothing short of astounding.

Gary Schwitzer, professor of journalism at the University of Minnesota (and former editor-in-chief of the Mayo Clinic’s consumer health website), has been doggedly following the story on his excellent and always-ahead-of-the curve blog about the media and its coverage of health news. On Monday, he published a list of the 10 major things we’ve learned from “the mammography week to remember.”

Be ready to feel discouraged. After reading the list, you’ll undoubtedly wonder if we’ll ever accomplish true health care reform in this country.

Here is Schwitzer’s list:

1. Many in the general public (most of those quoted in news stories) are not prepared for evidence to be used in making health care recommendations. They haven’t been prepared by the health care industry, by their physicians, or by the news media.

2. Many in health care (many of those quoted in news stories) are too invested in their own preferences to allow evidence to make a difference in their practices.

3. There is an undeniable and clear bias in many news stories, reporters and news organizations for promoting screening — evidence be damned. … (Mind you — I said “many,” not “all.”)

4. The USPSTF, which is a collection of independent experts, has no public relations arm. They simply review the evidence and publish their recommendations.

5. The public relations machinery of the American Cancer Society, the American College of Obstetrics and Gynecology — and other groups that opposed the USPSTF recommendations — helped the anti-USPSTF message rule the media all of last week.

6. Politicians chimed in — sometimes distorting the evidence beyond all recognition. The clash between politics and science at such times is predictable and disgusting.

7. The rhetoric used to oppose the USPSTF recommendations was the ugliest and most ill-founded I can remember.

8. There was some excellent journalism done on the issue last week, but it was overwhelmed by and drowned out by the drumbeat of dreck shoveled out by many news organizations — including in much (not all) of what was provided on network TV.

9. The week may have caused harm to the nation’s discussion of health-care reform.

10. The week was certainly a setback for the nation’s understanding of science, of evaluation of evidence, of the potential harms of screening tests.

Comments (2)

  1. Submitted by L.A. Krahn on 11/24/2009 - 03:24 pm.

    Thank you for this balanced evaluation, especially the Schwitzer blog link.

    I, too, was shouting back to the radio all day as this “news” broke. Even MPR was decidedly unbalanced, offering in its news recap a shock aspect and not the science or statistics or facts of any kind. When HHS Secretary Sebelious later distanced herself from the recommendation, I wondered what planet I was on.

    Braver and smarter folks are needed to step up if evidence-based medicine is to succeed.

  2. Submitted by Michael Zalar on 11/27/2009 - 04:48 pm.

    This is, I suppose anecdotal and does not fit with the study, but three years ago, when she was 40 my wife had a mammogram and a lump was found.
    It was removed, a biopsy done, and it was found to be cancerous, with a very few cells showing up in one of the lymph nodes.
    Outcome based health science is fine, and probably statisstically there would be no more women dying by changing the age to start recieving mammograms from 40 to 50. However in this specific case, and on a very personal level, it was important that my wife recieved her mammogram at age 40.
    She is a survivor and is doing fine.

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