New mammogram guidelines provide case study for medical testing: Bloomberg

With medical testing on the rise, companies are eager to jump on the bandwagon with products geared toward consumers. But more testing doesn't always translate into better outcomes for patients, some experts say, and the latest recommendations on breast cancer screening provide a case in point.

The U.S. Preventive Services Task Force earlier this week issued its final guidelines on when women should start getting mammograms, saying that women ages 50 to 74 should undergo screening every two years and that women in their 40s at an average risk for breast cancer should decide for themselves whether to get tested after they "weigh the potential benefit against the potential harms," Bloomberg reports. In 2009, the task force laid out similar recommendations after studies showed that screening women in their 40s comes at the risk of many false positives for the disease.

According to the latest recommendations, which were published in the journal Annals of Internal Medicine, screening 10,000 women in their 40s prevents about four deaths from breast cancer over 10 years, Bloomberg reports. Every time 10,000 women in their 40s have mammogram screening, there are more than 1,200 false positive results, often leading to unnecessary biopsies. Mammograms also result in missed cancers, with every 10,000 mammograms yielding 10 to 13 false negatives.

Kirsten Bibbins-Domingo, vice-chairwoman of the Preventive Services Task Force

But the guidelines aren't meant to discourage women in their 40s from getting mammograms. "We have tried to really clarify what the science is telling us about the benefits of mammography screening for women age 40 to 74," Kirsten Bibbins-Domingo, vice-chairwoman of the Preventive Services Task Force, told The Wall Street Journal. The task force's 2009 guidelines were "widely misinterpreted as a recommendation against screening for women in their 40s," Bibbins-Domingo said, and the latest recommendations should offer clarity.

Other groups have a different take on mammogram screening. The American College of Obstetricians and Gynecologists (ACOG) and the National Comprehensive Cancer Network, a nonprofit network of leading cancer centers, recommends that women begin getting mammograms at age 40 and continue having them every year, The Wall Street Journal points out. Even though medical groups historically agreed on mammogram guidelines, recent research has caused a rift.

The debate is likely to continue, especially in light of increased scrutiny for medical testing. The FDA is ramping up its oversight of tests, saying last year that it would look into the effectiveness of 20 diagnostics including ovarian cancer tests and prenatal tests for birth defects. Certain ovarian cancer tests showed cancer even when none was present, and prenatal tests yielded inaccurate results that caused some women to end their pregnancies.

"What drives the desire to monitor or to do things is kind of an unrealistic feeling that you're always better off if you do these things, or you're better off knowing," Lisa Schwartz, professor of medicine at the Dartmouth Institute for Health Policy & Clinical Practice, told Bloomberg. "Is there any evidence that doing this test is going to help me feel better or live longer? For most of these tests, the answer is no."

- get the Bloomberg story
- here's the WSJ article (sub. req.)

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