Opinion Pieces Examine Issues Related To Breast Cancer Screening

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~ John Allen Paulos, New York Times Magazine: President Obama "promised to restore science to its 'rightful place,'" and that "has partly occurred, as evidenced by this month's release of 13 new human embryonic stem-cell lines," Paulos, a professor of mathematics at Temple University, writes in a Times Magazine opinion piece. However, the "recent brouhaha" over the U.S. Preventive Services Task Force's guidelines on breast cancer screening, "illustrates how tricky it can be to deliver on this promise" because some "people may not like or even understand what scientists say, especially when what they say is complex, counterintuitive or ambiguous," he continues. According to Paulos, "both the panel's concerns and the public's reaction ... may be better understood by delving into the murky area between mathematics and psychology." Paulos writes that "[m]uch of [the] discomfort with the panel's findings stems from a basic intuition: since earlier and more frequent screening increases the likelihood of detecting a possibly fatal cancer, it is always desirable." He explains that the bulk of screenings that detect cancer will be false positives, adding that "it's not easy to weigh the dangers of breast cancer against the cumulative effects of radiation from dozens of mammograms, the invasiveness of biopsies ... and the aggressive and debilitating treatment of slow-growing tumors that would never prove fatal." Paulos also notes, "Since we calculate the length of survival from the time of diagnosis, ever more sensitive screening starts the clock ticking sooner," and "[a]s a result, survival times can appear to be longer even if the earlier diagnosis has no real effect on survival." He concludes that "the bottom line is that the new recommendations are evidence-based" (Paulos, New York Times, 12/13).

~ Nancy Brinker, Newsweek: Although breast cancer early detection and survival rates in the U.S. "have improved dramatically," in other countries, "the picture is bleak and getting bleaker," Brinker, founder and CEO of Susan G. Komen for the Cure, writes in a Newsweek opinion piece. Citing a recent Harvard University study, Brinker writes, "Of the more than one million new cases expected next year, almost half will be fatal -- and 55% will come from poorer countries in Africa, Asia and Latin America." The study also projected that by 2020, 70% of newly diagnosed breast cancer cases would "be found in these comparatively disadvantaged parts of the world, where treatment is scarce and the social climate" is not "progressive," she writes. Mammograms, "the subject of much recent debate, are not perfect," Brinker notes, adding that they "lead to false positives, unnecessary biopsies and profound anxiety." She writes, "The technology must become more capable of distinguishing between deadly, aggressive tumors that need to be treated and relatively safe slow-growers that don't," but "right now, mammograms are the best screening tool we have." They "save thousands of lives each year in this country," Brinker writes, adding, "So rather than debate what age to start screening, and how frequently to do so, we should focus on increasing access to mammograms for everyone -- not creating artificial impediments for the relatively few women who are able to get one" (Brinker, Newsweek, 12/12).

Reprinted with kind permission from http://www.nationalpartnership.org. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.

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