Breast Cancer Screening: New Fuel for an Old War of Words and Data
By Charles Bankhead, Staff Writer, MedPage Today
Published: November 19, 2009
A controversy that has alternately simmered and boiled for more than 40 years reached a flash point this week when the U.S. Preventive Services Task Force published recommendations for breast cancer screening with mammography.
The recommendation to delay routine screening in average-risk women until age 50 brought out ardent supporters on both sides of the issue, as reflected in coverage by MedPage Today and in consumer and professional media from coast to coast.
Although media coverage might have created the impression of a new controversy, the strong, conflicting opinions go back at least as far as 1969, when initial results of the first large-scale breast cancer screening program were announced. Data from the Health Insurance Plan (HIP) of Greater New York showed a 30% reduction in breast cancer mortality in women ages 40 to 64 who underwent clinical breast examination and screening mammography (JAMA 1971; 215: 1777-85).
With longer follow-up, the HIP data suggested the mortality benefit of screening was limited to women ages 50 and older. By 1977, the authors of that study had concluded that women ages 40 to 49 did not benefit from screening (Cancer 1977; 39(suppl): 2772-82).
Shortly afterward, a Swedish study demonstrated a beneficial effect of breast cancer screening in women ages 40 to 74 (Radiology 1981; 138: 219-22). In contrast to the HIP data, follow-up for as long as 20 years showed a mortality benefit in women ages 40 to 49, as well as older age groups (Lancet 2003; 361: 1405-10).
Several other studies reinforced the value of breast cancer screening, and mammography gained widespread acceptance among physicians and scientists alike. However, disagreements persisted about the purported benefits of screening in younger women and about the appropriate screening interval (Int J Epidemiol 2004; 33: 43-55).
http://www.medpagetoday.com/HematologyOncology/BreastCancer/17127The Republicans are using this controversy as an example of what is going to happen with "rationing care". They are either ignorant of the facts or lying outright.