Today's longread looks at a similar issue but at the opposite end of the cancer continuum: early detection. A central theory that has guided many years of cancer research and clinical practice is the idea that earlier detection of cancer means better outcomes for patients. While this is true on a general level (an earlier stage cancer almost always has a better prognosis), the challenge lies in finding tests that work effectively for early detection. Mammograms, which have become a staple of preventive medicine for women over age 40, are imperfect in this regard. While the research results are more complicated than this article implies, much of the opposition to changes to mammogram screening guidelines (such as those two years ago that suggested a starting age of 50 instead of 40) is based on what the author calls the "mammogram economy." This isn't to say that we should do away with screening mammography altogether, but we should do our best to let science guide us toward standards that both reduce costs and improve the well-being of patients.
For anyone interested in the research that has been done on mammograpy as a screening tool for breast cancer, here are some useful links:
- National Cancer Institute breast cacner screening summary: http://www.cancer.gov/cancertopics/pdq/screening/breast/Patient/page1/AllPages
- NCI breast cancer screening summary for health professionals (this is much more technical but goes through the studies one-by-one): http://www.cancer.gov/cancertopics/pdq/screening/breast/healthprofessional/page1/AllPages
- US Preventive Services Task Force (USPSTF) recommendations: http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm
"Ignoring the Science on Mammograms" by David H. Newman, M.D.
Published in the New York Times, November 28, 2012
http://well.blogs.nytimes.com/2012/11/28/ignoring-the-science-on-mammograms/
Eric
So, once something like a mammogram is determined to not be effective, who decides to stop using it in the hospitals? Is it up to the individual hospitals, doctors, or can a larger institute 'discontinue' a type of treatment?
ReplyDeleteAny of those actors has the power to change the way any test or procedure is administered. A doctor can start by not offering a referral. Hospitals or larger medical facilities can reduce the amount of procedures they do (screening mammograms, for example). Insurance companies or Medicare can also influence practice based on what they do or do not cover. In the case of certain procedures or treatments, the FDA could rescind approval (although that wouldn't happen for something like a screening mammogram).
ReplyDeleteEric