New Mammogram Guidelines Make 'Good Arguments,' Opinion Piece Says

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"A federal advisory panel recently set off a controversy by recommending that most women without special risk factors delay breast cancer screening until they turn 50, not 40, and that mammograms take place only every other year," Richard Thaler of the University of Chicago writes in a New York Times opinion piece. He adds that although the guidelines "have been called a rash misjudgment and an example of ostrich-like thinking," this "criticism is unfair ... to the scientists who prepared the report."

According to Thaler, the report "makes some good arguments, and a discussion of the underlying numbers and a bit of probability theory may help explain how the scientists reached their conclusions -- and help us evaluate the policy implications." He adds, "Analyzing this problem also highlights the difficulties in gauging health care reform: Should we continue any test that offers some chance of preventing a death, regardless of the odds or the costs associated with the testing?"

The "numbers show that about 2,000 women need to be screened regularly for a decade to avert one breast cancer death," and "during that decade, between four and 20 of these women will be 'overdiagnosed' and get radiation, chemotherapy or a mastectomy unnecessarily," Thaler writes. He adds, "And when you add up a decade of false positives, hundreds of these women will have received false alarms -- and about half of these will have received biopsies." According to Thaler, it is "safe to say that our current medical care system is not designed to do well at making these decisions. Careful medical and scientific recommendations are turned into political footballs, and doctors are often paid for testing and treating and run the risk of being sued or rendered guilt-ridden for not doing so." He concludes, "One can make a good case that we don't want the government making these choices, but few want those decisions made by private insurance companies, either" (Thaler, New York Times, 12/20).

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.

© 2009 The Advisory Board Company. All rights reserved.

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