Network News

X My Profile
View More Activity

Still confused about mammograms?

Jon Cohn is right: Dr. Margaret Polaneczky explanation of last year's controversial mammography recommendations is the clearest assessment of the controversy that you're likely to find.

What the Task Force is saying is simply this - On a population basis, the net gain from adding 10 years of mammography in all women is small in relation to the risks of over-diagnosis, over treatment, unnecessary biopsies and anxiety. But you, as a patient, in consult with your physician and assessing your own personal risks of breast cancer, may decide you want to get a mammogram anyway.

What they meant to do was to take mammography out of the realm of the knee-jerk, automatic and into the realm of informed decision-making. They meant to inform women that mammography's 15 percent or so reduction in mortality comes at a price -- a price that is physical, emotional and financial, in the form of false positive results, unnecessary biopsies and the anxiety and dollar cost that accompanies them. They also meant to dispel popular overblown notions about what mammograms actually do by clarifying both their benefits and their risks, so that women are making the most informed decision they can about whether or not to have this potentially lifesaving test.

Unfortunately, they blew their 15 minutes. Which leaves it to the rest of us to clean up the mess.

Read the rest.

By Ezra Klein  |  January 7, 2010; 1:41 PM ET
 
Save & Share:  Send E-mail   Facebook   Twitter   Digg   Yahoo Buzz   Del.icio.us   StumbleUpon   Technorati   Google Buzz   Previous: More than cutting and taxing
Next: Supermajority retention

Comments

Count me as one who is thrilled about the new recommendations. If they want to give me another mammogram before the age of 50, they'll have to catch me first.

Posted by: KathyF | January 7, 2010 2:22 PM | Report abuse

Yep, it never ceases to amaze me how difficult it is to successfully communicate ... and how easy it is to fail.

In this situation, I really wonder if the committee actually spent any time discussing and planning the best way to communicate their message prior to releasing their report.

Fortunately for me, I heard Dr. Nancy Snyderman explaining it all (basically same message as Dr. Polaneczky) right after the report was released, so I was not swayed by the hysterical reactions to it.

I did notice that even Sibelius didn't do as good a job clarifying the issue as Snyderman had. I remember thinking Obama/Sibelius should hire Snyderman as their spokesperson on health matters.

Obama, even the great orator, needs much better communicators in his administration. Most who speak on his behalf just do not explain things in a way that average, every-day folks can understand. (Elizabeth Warren is an example of someone who does this very well). And, I've said it here before, I think you, EK, also do that very well. Not everyone has that skill.

You're also right about poor communication leaves a big mess for others to clean up; always more difficult than the time and effort it takes to get it right the first time.

Posted by: onewing1 | January 7, 2010 2:45 PM | Report abuse

The recommendation is flawed because it doesn't include recommendations for women with a family history. It just says "talk with your doctor" which is code for "we're not paying."

Posted by: bmull | January 7, 2010 2:54 PM | Report abuse

"So far, when presented with the data, every one of my low-risk patients age 40-50 has decided to have their mammograms."

I think that's the money quote. KathyF notwithstanding, people are more likely to worry about being the one who could have been saved than the one burdened with the trouble of a false positive.

Posted by: JEinATL | January 7, 2010 3:02 PM | Report abuse

Incentives in the medical profession lean toward treating and procedures, not informing. In fact, the current system tries to discourage docs from "wasting" time informing patients. Guess what? Patients are uninformed.

Posted by: janinsanfran | January 7, 2010 3:14 PM | Report abuse

One where I think US medicine does itself a disservice, albeit for understandable reasons, is in its tendency to minimize the risks of testing. While you don't want to discourage screening, treating invasive tests and screens with high false-positive ratios as having zero downside -- free withdrawals from the medical bank -- doesn't necessarily combine well with fee-for-service or highly interventionist medical approaches.

In short, as Ezra has said repeatedly, it's hard to break the "more is better" perception when it comes to testing, diagnosis and treatment.

That doesn't quite extend to pharmaceuticals, but even there, you have the problem that the TV fast-talk for contraindications and qualifiers diminishes perception of risk -- or even sets it up for ridicule, like the four-hour warning for ED pills.

Posted by: pseudonymousinnc | January 7, 2010 3:17 PM | Report abuse

In my experience "talking with my doctor" is like asking a car salesman for his advice on whether or not I should buy a new car--the answer is never "no." Oh sure, there's a lot of caveats mumbled, but the bottom line is always that more tests and more treatment is better, especially after you've got a good track record of paying your bills on time and your insurance looks good.

Posted by: AuthorEditor | January 7, 2010 4:28 PM | Report abuse

In my experience "talking with my doctor" is like asking a car salesman for his advice on whether or not I should buy a new car--the answer is never "no." Oh sure, there's a lot of caveats mumbled, but the bottom line is always that more tests and more treatment is better, especially after you've got a good track record of paying your bills on time and your insurance looks good.

Posted by: AuthorEditor | January 7, 2010 4:29 PM | Report abuse

You need to make a distinction between primary care docs and specialists. Primary care docs dont make a cent if they order a mammogram. Primary care docs dont make a cent if they refer you for a CABG or a cardiac cath.

Its the cardiologists, radiologists and surgeons who make money by doing more "stuff." Primary care docs make more money by seeing more patients, not by doing more "stuff"

Posted by: platon201 | January 7, 2010 7:08 PM | Report abuse

This article is a good reason why Ezra is wrong when he insists that a central govt panel who dictates what "good medical standards are" wont have any real teeth to cut costs. Its clear that mammograms are overused in this country, but when you throw in all the "uncertainty" and BS surrounding it, you get mealy-mouthed backtracked statements by people like Ezra who come out and say "forget what we said, just talk about it with your doc."

At the end of the day, it gets back to what we have right now: a million different doctors telling a million different patients different things. So much for "standards of medical care" cutting down costs.

Posted by: platon201 | January 7, 2010 7:11 PM | Report abuse

Platon 201 it is well known that doctors frequently own or have investments in the companies that do the diagnostic tests leading to further incentives to order up more and more. Here's a link on that subject: http://blogs.acponline.org/advocacy/2009/08/should-doctors-be-allowed-to-own-tests.html

Posted by: AuthorEditor | January 7, 2010 9:28 PM | Report abuse

The comments to this entry are closed.

 
 
RSS Feed
Subscribe to The Post

© 2010 The Washington Post Company