Medical journal finds divide between doctors and patients on new mammogram recommendations

News outlets explore confusion about cancer screening guidelines and questions raised about the effects of high tech procedures on health care costs and quality.

The Annals of Internal Medicine, which published mammography guidelines in November from the United States Preventive Services Task Force that recommended "most women start routine scans at age 50 rather than 40 and reduce the frequency to every two years, from once a year," this week has an editorial suggesting "that a divide has emerged between doctors and patients — with the doctors more inclined to accept the new recommendations and the patients wanting to stick to early and annual screening," The New York Times reports. The Annals' editorial was based on responses from "patients, doctors and other health care workers to the journal's request for online comments on the new guidelines. Most of the 345 doctors who responded said they would stop offering routine mammograms to women in their 40s, and most said they would advise women 50 to 74 to have mammograms only every other year." In comparison,"most of the 241 patients who responded said they did not believe in giving up routine mammograms in one's 40s ... and were not likely to switch to an every-other-year routine" (Rabin, 2/15).

The Associated Press reports on screening for colorectal cancer. "Nearly half the people who need potentially lifesaving checks for the nation's No. 2 cancer killer -- colorectal cancer -- miss them. ... But what if you opened your mailbox one day to find an at-home test kit, no doctor's appointment needed? The dreaded colonoscopy may get the most attention but a cheap, old-fashioned stool test works, too." And, when Kaiser Permanente chose to mail such test kits "to patients due for a colon check, its screening rates jumped well above the national average. Now specialists are looking to Kaiser and the Veterans Affairs health system, another program that stresses stool-tests, for clues to what might encourage more people to get screened for a cancer that can be prevented, not just treated, if only early signs of trouble are spotted in time" (Neergaard, 2/15).

The Fiscal Times/Kaiser Health News: "The U.S. leads the world in creating state-of-the-art diagnostic and therapeutic treatments with the potential to work miracles in millions of patients. But the miracles come at a stiff price. Unlike other industries where technology has helped lower costs by eliminating waste and increasing productivity, technology has become a major factor in increasing health care costs. ... One reason for this dichotomy is the overuse and misuse of technology as preventive medicine."

"Since 2001, the number of scanning machines in the U.S. has increased by over 20 percent, while the number of scans taken each year has gone from one for every seven persons to almost one for every four. Yet there's no evidence that the additional invasive procedures that result from this large increase in screening are preventing serious heart disease" (Goozner, 2/15).