Friday, December 4, 2009

Mammography Guidelines Revisited

Reaction to the updated mammography guidelines -- see previous posts on the topic -- from the US Preventive Services Task Force (USPSTF), a panel of experts charged with determining guidelines for cancer screening, has reached partisan proportions. Republicans are trending toward outrage and Democrats sympathy.

At least that's how Alicia Mundy of the Wall Street Journal reads what's happening in her article published in today's Journal.

But, should politicians really be involved in this debate? Given the complexities I've outlined in previous posts, I'm pretty much opposed to it!

According to Mundy,
"Some House members wanted to know why the task force, didn't include cancer specialists. Dr. Calonge said the task force excluded people with "financial, intellectual and other conflicts" of interest."
Ok. Well those sorts of questions are fine. But some of these comments she has in there are outrageous.

Currently, the mammography uproar seems to have been fueled by the effective communication of a public health message that now needs to be tweaked to match changing scientific evidence. Or does it?

What if the public health message needs to change?

Change isn't easy. It sounds good in speeches, but implementing change is hard. Creating effective change is even harder. How can you make a mammography screening guideline as nuanced as "All women should get screened every two years beginning at age 50, and if you are at more than moderate risk of breast cancer, start getting screened at age 40?"

Susan G. Komen and other cancer prevention organizations have built their brand off a simple message: Get a mammogram every year when you turn 40. They have promoted mammography screening arguably better than any local, state, or federal department of health ever could.

So practically, I think that few women would have heard about these new USPSTF recommendations had it not been for the media uproar. Time will tell whether the issue dies down, and the the non-profit leaders continue to stick to message and mission: preventing breast cancer through promoting the use of mammograms.

I wonder whether a more complicated, nuanced message will stick -- or if this whole debate will lead women to abandon mammography screening, until it really is too late.

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