Barbara Ehrenreich has a post on the new mammography guidelines.

Also, the more screening they do, the more false positives they find (I am one of those false positives, had a lump removed and everything), which also means misery and suffering.

However, you would think that they would be trying to improving screening to differentiate between cancers and reduce false positives… and not just do less testing.

And what you call “conflict of interest”, I call “expert opinion”. If any unsound science were in evidence from his posts, you might have a point there. But what, you’re saying we’re not supposed to trust professionals to tell us about their profession? That is absurd.

Early detection is a Very Good Thing in women whose masses were malignant. But there are also plenty of cases where a mass is benign, or where it grows too slowly in an older woman to become life-threatening before she dies of other natural causes first, or even where it spontaneously regresses. We just don’t have the methods yet to be able to tell the killing cancers from the others, and individual screening and treatment must become a balancing act at the patient level. Many people feel that, yes, offuckingcourse they want to be screened every year and treated the hell out of, sure. Some people are 85 with a host of other health problems, and don’t really want to spend your last few years or months going through surgery/radiation/chemo when they find a tumor.

And you can bet that there is a lot of ongoing research into novel cancer detection, identification, and treatment methods. The university I work at just recently finished building a new center specifically for cancer research, for example, and the field is definitely a big one.

Really though, I’m in a different field of research (diabetes), so anything I say about cancer is going to be secondhand, coming from general science knowledge and reading what oncologists have to say.
Orac could definitely give you better context on current trends in breast cancer treatment and survival rates. The 5-year survival for many cancers has increased significantly as a result of better therapies. (And for many, the rate is still very dismal.. the problem of cancer being many many different diseases that we are still trying to unravel.) Here’s an excellent pair of posts from 2007 (can I post links here? I’ll try), and a couple others you might find relevant to your other questions.
http://scienceblogs.com/insolence/2007/04/detecting_cancer_early_part_1_more_compl.php
http://scienceblogs.com/insolence/2007/04/early_detection_of_cancer_part_2_breast.php

http://scienceblogs.com/insolence/2009/08/cancer_research_and_clinical_trials.php

http://scienceblogs.com/insolence/2007/10/breast_cancer_in_time_magazine.php

But here’s one thing that confuses me, and if I should just go over to Orac, please tell me. The bottom line seems to be that the screening protocols we’ve been doing do not change mortality rates. So some breast cancers, regardless of when they are detected, are going to end up killing you (unless you get hit by that truck or meteor).

But more and more, we’re seeing women live for many years with breast cancer, to the point that in some cases, it’s more like managing a chronic disease. There are horrible times, like the surgery and the chemo, and less horrible – sometimes really good times – when the cancer is in remission, and you can live your life. I don’t want breast cancer, none of us wants it, but isn’t early detection a good thing if it helps us manage it and live better, longer?

Do mortality rates reflect this increasing ability to manage certain breast cancers for a good long while? I wonder, too, if they are working on other, adjunct ways to detect breast cancer, or to identify risk markers, ways that don’t irradiate you or involve surgery. And of course, there’s the whole field of figuring out environmental causes and links – even if the links are to substances found in hugely lucrative mass-marketed products or foods.

I’m also a doctor. And I’m also a patriarchy blamer which I’ve been for longer than I’ve been a doctor.

However from reading the recommendations as reported in the Washington Post article I have to blame the way this task force decided to distill its messages to women and doctors.

I agree with the principle of no routine mammography of the pre-menopausal population, and the key word is routine i.e. regular tests on a whole-population scale.

A ’screening’ test is different in public health jargon from an ‘investigation’ test – investigations are something you undergo if you are suspecting a disease, screening is something you undergo if you start out not suspecting. In public health textbooks (and probably emedicine) there is a list of criteria to determine whether a screening test is useful or not, and one creteria is that the screening method has to have few false positives and few false negatives. Mammography in young people is not sensitive or specific enough to be a good screening method. So I agree with the recommendation that it should not be a routine for all women under 50.

As Medstudent says, for women in their late 40s it remains to be seen what the best screening test is. The UK National screening programme is aiming to reduce its starting age to 47 rather than the present 50 because it plans to introduce digital mammography rather than plain-film as is the case now. Digital mammography in some studies has been shown to be a better method for women over 40 which is what the NHS is basing its move. I’m not sure what is being used in the US (I’m guessing possibly a mix of both, as per the individual’s insurance?) but this recent task force’s conclusion on the type of mammography was that they could not recommend one over the other.

My main conclusion from this is that all plans for routine screening are based on large, whole-population numbers and we know that a few pre-menopausal women most definitely get and die from breast cancer. Women of all ages should be made aware that if they are concerned about their breasts – from strong family history or after feeling a lump – they should have a discussion with their doctors about their own individual risks, and if necessary have screening tests or investigations.

Someone mentioned cervical screening and whether the starting age should be kept at 18 years. I haven’t made my mind up about this personally, but in England we are screened every 3 years starting from 25 years. The reason for this starting age from the national public health authority is that the normal under-25 cervix is in a state of perpetual change, cell-wise, therefore a ‘normal’ and ‘abnormal’ smear at this age are too alike and so the smear test is not a good pre-cancer screening method for younger women. Furthermore they speculate that the benefit from the HPV vaccine will be seen in this next generation of screenees. If anyone’s interested in reading a very dry blow-by-blow account of how they arrived at this conclusion it’s on http://www.cancerscreening.nhs.uk/cervical/cervical-review-minutes-20090519.pdf .

BUT public health authorities should be making women, especially these younger-than-the-starting-age-of-cervical-screening women aware that if they are experiencing any unexpected spotting or bleeding, this could be a symptom of cancer in a small number of cases and they should see their doctor. They should also make women more aware of HPV and what we know so far about how it causes cervical cancer, and how it’s contracted. This is not currently happening.

Sorry for the giant reply. I’m glad this discussion is happening because I am happy that women are bothered about their collective health. ‘Men’s rights activists’ claim that women’s health gets more money and attention than men’s. This is blatantly untrue. Please continue to be angry at injustice, and please also take time to read the literature behind recommendations. It’s a shame that those in charge of distilling the evidence-base into advice have been doing it in such a shoddy way. We have to try and educate ourselves.

In an entirely unrelated (ha!) report, the US government is now recommending that women in their 20s can go two years between pap smears instead of going to the gyno annually. The reason for this conclusion is that cervical cancer has one of the slowest growth rates. Interestingly enough, none of the news releases of the study I’ve seen have mentioned the fact that African American women are twice as likely to develop cervical cancer, and Native-American and Hispanic women also suffer from significantly higher rates of the disease. The governmental panelists claim that surgeries of the cervix can lead to fertility problems and preterm delivery, but I know for a fact that surgeries are only performed on women who have malignant cellular changes. In the long run, I’d much rather not, ahem, die of cancer than carry a child. Fucking receptacles and incubators for the patriarchy; that’s all that matters.

I worry about this “recommendation” for several reasons. At the age of 24, I developed early stages of cervical cancer and had to go through some pretty gnarly treatments. I’d rather not think about what I may have had to get done if I’d waited two years. Two of my good friends wound up in the same situation. We have always insisted on yearly (or even biannual) exams. We aren’t just faceless statistics. Annual exams aren’t just for detecting possible cervical cancer: they also screen for other life-threatening STDs and conditions. It’s not like dudes are lining up each year to get their junk checked out (the threats that women face due to dudely apathy regarding sexual health is another matter for another day). Many women are already reluctant to go annually; I wonder if this recommendation will lead even more women to wait years between exams.

If x people get better with a certain treatment but y people don’t and z people’s health gets worse, inevitably there will have to be some sort of math that takes into account the numbers and cost of z plus y people versus x people, until we figure the f*** out about how cancers work. We say “breast cancer” but we mean “cancers of the breast”- they are harder to identify than insects in the Amazon, ever cancer of every tissue is many, many different diseases, which makes guidelines or suggestions for policy end up being based on x,y,z type rationales.