From the amount they complain about having their boobs squished in the course of a mammogram, you would think women would be happy that the new recommendations are to do less.

But no.

Well of course I am being facetious and obnoxious here, although this recommendation by the US Preventative Services Task Force (USPSTF) that mammograms should not be routine before age 50 is serious stuff.

Doesn’t mean you shouldn’t ever have one before 50, if you and your doctor think it is the right thing - just the USPSTF thinks there’s not enough evidence of benefit that the upside (detecting breast cancers) out weighs the downside (unnecessary further tests like biopsies, repeat mammograms, sonograms, expense, anxiety, discomfort and even treatment of cancers that would never have grown enough to have affected the woman’s health significantly) that it warrants  being recommended as a routine exam between age 40 and 49 - as it was before these newly forged guidelines.

“But even before age 50, mammograms detect cancers, and there are innumerable women who had breast cancers detected in their 40’s screaming bloody murder about this new guideline” I hear you object.

It all comes down the Orwellian sort of idea of risk/benefit ratio and very often to money. Or how much should we spend to save someone’s life, or extend it?

“You can’t put a price on a human life” I hear you objecting again (I wish you’d just shut up and stop all this objecting).

The reality is that you can and we DO. There are many instances where the cost of some test or treatment is just too prohibitively expensive for the person to get, and they die - and incidentally, if you are one of those people who don’t have insurance, that can often be something as mundane as your blood pressure pills. But often the money you save in one place can produce much greater benifit in another.

You could argue MRI scans are super sensitive at detecting breast cancer - up to 100% in some studies. So why don’t we do MRI scans on every-body? (or every-boob). The answer is, because they’re too damn expensive.

In the world of clinical studies, the common measure for deciding if some treatment is worthwhile is “number needed to treat”. The USPFTS used a rather weird variation on this - “number needed to invite to extend one woman’s life”. Their conclusion was that you have to do 1904 mammograms to extend the life of one woman in the 40 to 49 age group.

So all you punters out there. Is that good odds?

The unfortunate and uncomfortable reality is that funds are limited and somehow we have to decide where we’re going to spend them - and this is emotive stuff.

If you’re the individual who had a breast cancer diagnosed before age 50 by mammogram, you’re probably going to have a pretty strong opinion about this. And the loud and vexatious people of this world are trying to convince us that this the beginning of “Obama-care”. Curtailing of health care. 

But we have to take the global perspective. To my mind, this is what the USPSTF is making a rational stab at - with this new fangled idea of “evidence based medicine”.

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