What are people supposed to think after reading Gina Kolata's article, Vast Study Casts Doubts on Value of Mammograms?
The mammography controversy stirs emotions because...
- The stakes of under-diagnosing and under-treating are high.
- The stakes of over-diagnosing and over-treating are high.
- People have been touched by breast cancer, personally or in a loved one.
- Change and uncertainty are uncomfortable.
Basic ideas to keep in mind:
- The science of screening studies is complex.
- Recommendations, at best, are provisional. And that's good. It means we are acquiring new information and developing new treatments that keep changing the equation.
- Earlier treatment of cancer is usually better. But it's not better in cases where the disease can be treated or cured just as successfully if found a bit later. Or in cases where, had the patient waited, newer treatments would be used that are equally -- or more -- effective and less toxic and/or less disfiguring.
My conclusions after reading the article are that physicians and patients must work together to...
- Tailor recommendations to each unique situation, based on the risks and benefits for mammography as derived from population studies.
- Optimize the use of self-exam and exam by clinicians.
- Educate everyone with sound information about changing recommendations, based on changing knowledge and changing treatments.
- Develop better methods of prevention, detection and treatment
- Honor past decisions made for patients based on past knowledge; prevent today's patients from making decisions today based on outdated information.
- Nourish hope of making the best decisions and enjoying the best possible outcomes