The XX Factor

Screen Less

Emily B , I agree with you that it’s really unfortunate that the conclusion that we don’t need to routinely do mammograms until 50, instead of aparking a national, rational discussion about the advisability of “screening and prevention,” has become the harbinger that we’re all going to live under British health care rationing. The debate over whether we benefit from searching for early cancers is not new, and no wonder the public is so confused. This is like the “no fat” to “no carbs” pendulum swings on official diet recommendation. First we’re told looking early for breast cancer is the way to save lives; now we’re told look too early and often and we mostly finds lumps that are benign. Barack Obama has said that improved detection and prevention under his health care plan will lead to Americans being healthier, but this government task force on mammograms raises questions about what that means and whether it works. And now the administration, when confronted by evidence that we should do less, realizes it can’t take that political hit. As Steve Pearlstein writes, this is not good news for our ability to contain costs.

There’s no way to take the politics out of health care. But instead of seeing this debate as something sinister, we all would benefit from constant reexamination by the medical profession of its recommendations about how we should be examined. A few years ago, CT scans were supposed to revolutionize lung cancer treatment. Finally, we had a technology that would discover these tumors before they became deadly. But it turned out the screening didn’t save lives, it picked up tumors that wouldn’t have progressed. So this wasn’t a matter of “anxiety,” as in the false-positive mammogram. This meant people were being treated for a cancer that would have just sat there had it not been found.

In the mammogram debate, we are mostly hearing from the women who are angry and fearful that their annual mammogram will be taken away. But I wish that in my 40s my doctor hadn’t lectured me every year that I was overdue for a mammogram, and instead we’d been able to discuss when it made sense to start and how often I should have one.

Photograph of mammogram by John Foxx/Stockbyte/Getty Creative Images.