Editorial: Statistics alone not a basis for determining health care
No sooner had the U.S. Preventive Services Task Force report hit cyberspace Monday than doctors and patients across the country lined up to dispute it.
Specifically, the task force’s recommendations that women forego regular mammograms until age 50, at which point they should have them only every two years, drew the ire of those who have spent the last few decades preaching and practicing annual breast cancer screenings beginning at age 40.
The task force report, which is based on complex statistical models, also says its analysis provides no statistical evidence to recommend regular self-examination as a preventative measure against breast cancer.
Of all the health discussion going on in America today, there is very little that could have surprised us more than the contents of this report, not to mention the timing of its release — at a time when the cost and benefits of preventive medicine are being hotly debated as Congress tries to establish a national health-care policy. We were far from alone.
“It seemed to be a step backward,” said Dr. Karen Hoelzer, a Springfield Clinic oncologist.
By Wednesday, the tsunami of confusion over the report prompted U.S. Health and Human Services Secretary Kathleen Sebelius to issue a statement in response.
“My message to women is simple. Mammograms have always been an important lifesaving tool in the fight against breast cancer and they still are today,” Sebelius said. “Keep doing what you have been doing for years — talk to your doctor about your individual history, ask questions and make the decision that is right for you.”
Likewise, the American Cancer Society reiterated its recommendation for annual mammograms beginning at age 40.
“The American Cancer Society continues to recommend annual screening using mammography and clinical breast examination for all women beginning at age 40. Our experts make this recommendation having reviewed virtually all the same data reviewed by the USPSTF, but also additional data that the USPSTF did not consider,” said Dr. Otis W. Brawley, the American Cancer Society’s chief medical officer.
Brawley also states plainly what those brave enough to tackle the report on their own might discern: “With its new recommendations, the USPSTF is essentially telling women that mammography at age 40 to 49 saves lives; just not enough of them.” The study says that mammograms reduce the risk of death by breast cancer by 15 percent in both the 40-49 and 50-59 age groups, notes Brawley. “But because women in their 40s are at lower risk of the disease than women 50 and above, the USPSTF says the actual number of lives saved is not enough to recommend widespread screening.”
Brawley notes also that mammography is constantly becoming more precise and says “data show the technology used today is better than that used in the studies in this review.”
We’ve heard no argument this week that, from a statistical point of view, the USPSTF report is inaccurate.
But what we’ve heard extensively is this: Sound medicine isn’t practiced by math alone. It would be tragic for insurance companies to reduce their coverage of mammograms based only on the task force’s data, and we believe decisions on preventive care should always be collaborative efforts between patients and doctors.
Springfield (Ill.) State Journal-Register