# No mammograms until 50? **URL:** \ **Category:** In My Humble Opinion\ **Created:** [November 18, 2009, 1:41pm UTC](https://boards.straightdope.com/t/no-mammograms-until-50/518024 "2009-11-18T13:41:15Z")\ **Posts on this page:** 20\ **Page:** 4
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [November 19, 2009, 4:35pm UTC](https://boards.straightdope.com/t/no-mammograms-until-50/518024/61 "2009-11-19T16:35:32Z")
> [@ivylass](#): > > **Qadgop** , please help me understand. I was not high risk. I had no family members who had breast cancer. I don’t smoke. My lump was found with a routine mammo at age 40. > > Since there were no red flags, are you saying I should have waited 10 years for a mammo or until the lump got so big as to be noticeable? (note the panel is also saying self-exams don’t work.) One can’t look at individuals when deciding how to design screening programs, unfortunately. They’re built to handle large numbers of people, for the net benefit to all, even though some folks will die despite/because of the screening. The conundrum is: that for every case of breast cancer identified and intervened on in time to save a life, it appears that 10 women will have unnecessary/futile surgery, chemo and/or radiation. Some of those women will be made sick by complications of those treatments, and eventually some will die prematurely because of it. The question is: Does that equation make sense? For every life saved from breast cancer, 10 people are damaged (at least to some extent) without benefit and perhaps one or more lives shortened. We all have within us the seeds of our own demise. We can’t screen for everything, and the screening tests we use need to help more folks than they hurt. And be cost-effective. Spending $1 billion only for a net savings of 1 life isn’t an equation that makes sense either. We can save lots more lives with the same money just in improving childhood vaccine access. I don’t know what the right equation is, or the right screening protocol. But we need to ask the questions, and look at the evidence, and admit it when our current protocols are questionable in their effectiveness. ---
**Author:** ![ivylass](https://avatars.discourse-cdn.com/v4/letter/i/9de053/32.png) [@ivylass](https://boards.straightdope.com/u/ivylass)\ **Post date:** [November 19, 2009, 4:42pm UTC](https://boards.straightdope.com/t/no-mammograms-until-50/518024/62 "2009-11-19T16:42:02Z")
But if women wait, and the cancer becomes more complicated, doesn’t that add to extra costs and “anxiety?” (Mastectomy instead of lumpectomy, possible mets, more extensive post-op treatment) Isn’t an ounce of prevention worth a pound of cure? ---
**Author:** ![Philster](https://avatars.discourse-cdn.com/v4/letter/p/13edae/32.png) [@Philster](https://boards.straightdope.com/u/Philster)\ **Post date:** [November 19, 2009, 4:47pm UTC](https://boards.straightdope.com/t/no-mammograms-until-50/518024/63 "2009-11-19T16:47:50Z")
\*\*So I guess they are preparing to reduce services in case government-run health care becomes reality. \*\* ---
**Author:** ![Marley23](https://avatars.discourse-cdn.com/v4/letter/m/45deac/32.png) [@Marley23](https://boards.straightdope.com/u/Marley23)\ **Post date:** [November 19, 2009, 4:50pm UTC](https://boards.straightdope.com/t/no-mammograms-until-50/518024/64 "2009-11-19T16:50:47Z")
> [@Marley23](#): > > There are 16 people on the panel, and eight of them are women. So I’m having trouble seeing the sexism inherent in the system here. I need to correct myself; I looked at the current membership list, not the list from the time the recommendations were made. Seven women, not eight, out of 16 panelists. ---
**Author:** ![DMark](https://avatars.discourse-cdn.com/v4/letter/d/e68b1a/32.png) [@DMark](https://boards.straightdope.com/u/DMark)\ **Post date:** [November 19, 2009, 4:59pm UTC](https://boards.straightdope.com/t/no-mammograms-until-50/518024/65 "2009-11-19T16:59:46Z")
> [@Qadgop\_the\_Mercotan](#): > > And that’s an example of a special type of high-risk patient who is currently and will continue to be encouraged to get mammograms and other breast evaluations at an early age and regularly. > > So how does her experience relate to the recommendation that low-risk women are better served to have fewer mammograms at a later age? What makes that advice stupid? Because women like my friend Candy are in denial, and all they need to do is see a headline “Wait until you are 50…” and she would have happily filed that away as fact and not read the fine print. If she had gone just once - and the doctor had heard her family history, she might have been talked into a regular yearly check up. Yes, it was stupid on her part to ignore the family history, but she is not the first person who put off having a check up - be it for breast cancer or men for prostate cancer - when you are afraid of getting bad news. It would be far better to start any statement with the words, “Women with no family history, or low risk, of breast cancer might not need to get a mammogram until they are 50…” ---
**Author:** ![wonky](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wonky/32/393_2.png) [@wonky](https://boards.straightdope.com/u/wonky)\ **Post date:** [November 19, 2009, 5:12pm UTC](https://boards.straightdope.com/t/no-mammograms-until-50/518024/66 "2009-11-19T17:12:24Z")
One of my high school friends had a breast lump at age 17. There are always going to be outliers, but building an entire medical guideline around outliers doesn’t seem to be the way to go. We do want to have a starting point for any screening, and it isn’t and shouldn’t be “If you have breast tissue you need yearly/monthly/weekly/daily mammograms.” I think we would all agree that would be too far, and not have mammograms available at all for anyone is too far in the other direction. So, where should the guidelines be placed? We have the option of using scientific studies and knowing exactly what the risks and benefits are of mammograms, or we can ignore those studies and guess. I’m in the former camp. My guesser is all worn out with trying to figure out why the cat likes to bite my toes and why my office currently smells like cookies. ---
**Author:** ![Marley23](https://avatars.discourse-cdn.com/v4/letter/m/45deac/32.png) [@Marley23](https://boards.straightdope.com/u/Marley23)\ **Post date:** [November 19, 2009, 5:16pm UTC](https://boards.straightdope.com/t/no-mammograms-until-50/518024/67 "2009-11-19T17:16:09Z")
> [@Dangerosa](#): > > If you are counting, for me that’s one sister, one aunt and one cousin - the daughter of the aunt. No known gene mutation however - its also two friends and the youngish sister of a third…all in five years. I may be a statistical anomaly. My real life circle isn’t that large. I feel like I’m being asked to apologize here. Nobody is saying that younger women should not get mammograms if they feel they should. This panel is saying that overall, for the entire group of women age 40 to 49 without other risk factors, mammograms do not improve survival when the odds of finding tumors and the harm from testing and treatment is considered, and that considering the same factors, testing every other year is preferable to annual testing. It’s a much more qualified statement, even if it still comes off as callous. > [@DMark](#): > > Because women like my friend Candy are in denial, and all they need to do is see a headline “Wait until you are 50…” and she would have happily filed that away as fact and not read the fine print. For about 20 years before these new guidelines came out, the USPSTF had recommended annual mammograms for women 40 and older. The American Cancer Society still does. If you’re in denial, it is incredibly easy to find rationalizations to support your view. ---
**Author:** ![rekkah](https://avatars.discourse-cdn.com/v4/letter/r/ee59a6/32.png) [@rekkah](https://boards.straightdope.com/u/rekkah)\ **Post date:** [November 19, 2009, 9:42pm UTC](https://boards.straightdope.com/t/no-mammograms-until-50/518024/68 "2009-11-19T21:42:40Z")
> [@ivylass](#): > > Since there were no red flags, are you saying I should have waited 10 years for a mammo or until the lump got so big as to be noticeable? (note the panel is also saying self-exams don’t work.) It is known that some “cancers” picked up on screening will actually go away on their own if left untreated (ductal carcinoma in situ: [http://www.networkofstrength.org/information/diagnosis/types/dcis.php](http://www.networkofstrength.org/information/diagnosis/types/dcis.php)). I don’t know anything about the cancer that you had, **Ivylass** but some women go through surgery, radiotherapy and chemotherapy (all of which cause harm and may even cause death themselves) for something _that would have gone away by itself._ They also then live the rest of their lives finding it difficult to get health insurance and life insurance because of their medical history, making it more difficult for them to be treated for other diseases that could kill them. They live with the fear that the cancer could come back or that their sisters or daughters might get it, and their families also live with that fear. They might even get another cancer due to the effects of radiation exposure from the scans and radiotherapy, or due to the toxic side effects of chemo. Statistically, women could (and probably do) die _because_ they had a mammogram. I do understand the fear and frustration for you as someone who has been diagnosed with cancer, and for those who have lost family and friends to it. However, screening _has_ to be looked at rationally and based on evidence, otherwise it _will_ harm more people than it saves. We don’t screen every girl from the age of 20 for breast cancer, because we know it would kill more women than it saves. There has to be a cut-off, and this report is saying that based on an evaluation of the evidence available, this cut-off should be moved. ---
**Author:** ![Vimp](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/vimp/32/4186_2.png) [@Vimp](https://boards.straightdope.com/u/Vimp)\ **Post date:** [November 19, 2009, 10:08pm UTC](https://boards.straightdope.com/t/no-mammograms-until-50/518024/69 "2009-11-19T22:08:37Z")
[USPSTF Mammography Recommendations Will Result in Countless Unnecessary Breast Cancer Deaths Each Year](http://www.radrounds.com/profiles/blogs/uspstf-mammography) Granted, this group (radiology professionals) has a vested interest in maintaining existing mammography schedules, but this article states that the USPSTF’s claim that their findings are not dictated by straight-forward cost-benefit analysis is just not believable. > [@](#): > > Reston, Va. — If cost-cutting U.S. Preventive Services Task Force (USPSTF) mammography recommendations are adopted as policy, two decades of decline in breast cancer mortality could be reversed and countless American women may die needlessly from breast cancer each year. The recommendations ─ created by a federal government-funded committee with no medical imaging representation ─ would advise against regular mammography screening for women 40-49 years of age, provide mammograms only every other year for women between 50 and 74, and stop all breast cancer screening in women over 74. > > “These unfounded USPSTF recommendations ignore the valid scientific data and place a great many women at risk of dying unnecessarily from a disease that we have made significant headway against over the past 20 years. Mammography is not a perfect test, but it has unquestionably been shown to save lives ─ including in women aged 40-49. These new recommendations seem to reflect a conscious decision to ration care. If Medicare and private insurers adopt these incredibly flawed USPSTF recommendations as a rationale for refusing women coverage of these life-saving exams, it could have deadly effects for American women,” said Carol H. Lee, M.D., chair of the American College of Radiology Breast Imaging Commission. > > Since the onset of regular mammography screening in 1990, the mortality rate from breast cancer, which had been unchanged for the preceding 50 years, has decreased by 30 percent. **Ignoring direct scientific evidence from large clinical trials, the USPSTF based their recommendations to reduce breast cancer screening on conflicting computer models and the unsupported and discredited idea that the parameters of mammography screening change abruptly at age 50. In truth, there are no data to support this premise.** > > \ > > \> **Although USPSTF states that their recommendations were not motivated by cost savings, based on the above, we cannot help but draw the conclusion that the taskforce recommendations amount to rationing on the basis of financial costs. The USPSTF’s analysis evaluates the number of lives lost under a variety of screening scenarios and then blatantly recommend the most “efficient” (i.e. less expensive) screening interval, not the one that saves more lives. Not only are these numbers based on the lowest estimate of benefit, but they have no meaning for the women being screened.** Each woman has a single screening study each year regardless of the yield of cancers. Numbers only suggest the relative “cost” of curing a cancer by early detection and the USPSTF has, arbitrarily, decided that the cost of saving women ages 40-49 is too high. > > USPSTF Selectively Reviewed the Literature, Ignoring Hundreds of Well-Regarded Studies on the Subject > \> The taskforce commissioned its own computer models that had never been subject to critical peer review, ignoring previously published computer modeling studies and direct scientific evidence from large clinical trials that contradict their conclusion. The recommendations also ignored peer reviewed journal articles that critiqued studies on which their recommendations rely. They did not consider literature that didn’t evaluate mortality as an endpoint. > > \> Notably, the USPSTF does not even mention the actual published data from Sweden and the Netherlands that directly show what happens when new therapies and mammography are introduced into the population. These studies demonstrate that it is mammography screening and not new therapies or practices that are responsible for most of the decrease in deaths over the past 20 years. > > \> The fact that hundreds of respected journal articles were ignored while another trial was translated from Russian to English for consideration by the taskforce makes the entire literature review suspect. > > The fact that hundreds of respected journal articles were ignored while another trial was translated from Russian to English for consideration by the taskforce makes the entire literature review suspect. > > \> The elaborate academic exercise that the taskforce conducted is obviated by one important truth – almost universally, clinicians will agree that breast cancer therapy is far more successful when the cancer is found at a smaller size and earlier stage by mammography. In Sweden mammography screening has decreased breast cancer deaths among women in their 40’s by over 40 percent. > > \> The taskforce makes assumptions that are contrary to the evidence. For example, the presumption that loss of life can be minimized if “high risk” women opt to be screened earlier or more frequently than recommended, overlooks the fact that about 75 percent of all breast cancers occur in women who are not at high risk. > > \> The taskforce ignored literature describing survey results that women prefer to experience false-positives if the overall result is finding additional cancers in the screened population. [In another peer-reviewed article](http://www.acpm.org/breast.htm) from the American College of Preventative Medicine, the authors note that there are a number of reasons that might explain the observed “low” rate of success for women under the age of 50: > [@](#): > > Estimates of mammography sensitivity range from 75% to 90% with specificity from 90% to 95%. The positive predictive value of mammography for breast cancer ranges from 20% in women under age 50 to 60% to 80% in women age 50-69. Randomized clinical trials (RCTs) have demonstrated a 30% reduction in breast cancer mortality in women 50-69 years who are screened annually or biennially with mammograms. (4) \*\*The data on women under age 50 are less clear. Conclusions regarding the value of mammography in these women are hampered by inadequately designed studies, including failure of randomization and inadequate sample size, low compliance in the intervention group, and high screening rates (cross-over) in the control groups. (5,6) A few studies have suggested adverse effects on mortality in the early years after screening implementation, but both the occurrence and potential etiology of these effects are poorly understood. (6,7) Even with meta-analysis, the combined sample sizes are too small to reach conclusions regarding the efficacy of screening women under age 50. (8) Likewise, data are sparse regarding efficacy of screening mammograms in women older than age 69. \*\* > > \ > > Currently, compliance with mammography guidelines is low, especially among women over age 60, those with low socioeconomic status, and ethnic minority women. Estimates vary widely; 10%-60% of women report having had mammograms in the preceding year, depending on the population and geographic area under consideration. (9) Low utilization of mammography has been blamed on financial/insurance barriers, lack of education, and most importantly, lack of encouragement by a physician. (10) … Cost-effectiveness estimates of mammography screening–based on methodology, population, and interval–vary widely; it is estimated that breast cancer screening costs $3,400 to over $83,000 per life-year saved. (11) The potential cost-effectiveness of screening is higher when screening older populations, partly because the incidence of breast cancer increases with age. I guess I’m unimpressed by the cherry-picking of the data - and the apparent disregard of hundreds of actual clinical trials - to support the most “effective” (read cheapest) treatment, regardless of long range mortality or morbidity considerations. ---
**Author:** ![Dangerosa](https://avatars.discourse-cdn.com/v4/letter/d/22d042/32.png) [@Dangerosa](https://boards.straightdope.com/u/Dangerosa)\ **Post date:** [November 19, 2009, 10:40pm UTC](https://boards.straightdope.com/t/no-mammograms-until-50/518024/70 "2009-11-19T22:40:36Z")
> [@Marley23](#): > > I feel like I’m being asked to apologize here. Nobody is saying that younger women should not get mammograms if they feel they should. This panel is saying that overall, for the entire group of women age 40 to 49 without other risk factors, mammograms do not improve survival when the odds of finding tumors and the harm from testing and treatment is considered, and that considering the same factors, testing every other year is preferable to annual testing. It’s a much more qualified statement, even if it still comes off as callous. You aren’t, and I understand the recommendation. But population stats are not individuals, and for me, an annual mammogram - even with the false positives, the risk of unnecessary procedures, brings more peace of mind than risk - I’ve watched breast cancer six too many times now. But I’m one person who’d have had them cut off if my sister had tested positive for the gene - so to me, the breasts are worth not much compared to the peace of mind. The problem with recommendations is that they get distilled down to one sentence, and we leave out the whole idea that populations are made up of individuals - each with a different profile and unique needs. ---
**Author:** ![even\_sven](https://avatars.discourse-cdn.com/v4/letter/e/dfb087/32.png) [@even\_sven](https://boards.straightdope.com/u/even_sven)\ **Post date:** [November 20, 2009, 12:39am UTC](https://boards.straightdope.com/t/no-mammograms-until-50/518024/71 "2009-11-20T00:39:11Z")
> [@DMark](#): > > Because women like my friend Candy are in denial, and all they need to do is see a headline “Wait until you are 50…” and she would have happily filed that away as fact and not read the fine print. I’ve never even gone to the dentist without filling out a family history chart that asks pretty specifically if you have any family history of breast cancer. ---
**Author:** ![ThirdOne](https://avatars.discourse-cdn.com/v4/letter/t/53a042/32.png) [@ThirdOne](https://boards.straightdope.com/u/ThirdOne)\ **Post date:** [November 20, 2009, 3:22am UTC](https://boards.straightdope.com/t/no-mammograms-until-50/518024/72 "2009-11-20T03:22:55Z")
Rekkah, that linked article about dcis indicates 30% of women may have invasive cancer within 10 years. That’s pretty high, imo. I happen to be one who _had_ dcis. My doctor didn’t tell me it might go away by itself. And honestly, even if I had known it might, I’m not so sure I’d want to take that chance. Would you? I had a lumpectomy and 6 weeks of radiation. For me, that was a small(er) price to pay than the risk of have cancer sometime down the road. Regarding radiation treatment causing problems with the heart, _my_ experience is that they aimed it so the only part of my body hit by the radiation was my breast and underarm. It did _not_ go deep enough to affect my heart. Obviously, I can’t address anyone else’s experience. It’s easy to paint with a broad brush, but when looked at individually, it’s difficult to say “all” women of a certain age. ---
**Author:** ![irishgirl](https://avatars.discourse-cdn.com/v4/letter/i/8edcca/32.png) [@irishgirl](https://boards.straightdope.com/u/irishgirl)\ **Post date:** [November 20, 2009, 12:31pm UTC](https://boards.straightdope.com/t/no-mammograms-until-50/518024/73 "2009-11-20T12:31:46Z")
I do understand where individual posters are coming from on this issue, but I’m afraid I’m still not infavour of annual mammograms for under 50s without other risk factors (and of course mammography isn’t ideal in young women anyway as the breast tissue often is too dense-ultrasound is often preferable). I’d rather prevent cancers by reducing modifiable risk factors in ALL women. Efforts to: Promote breastfeeding and encourage women to continue beyond weaning (and society to accept that it is normal for children up to 2 years old to breast feed). Reduce alcohol consumption among women Reduce levels of obesity would actually reduce the numbers of cancers- for example breast feeding a single child to the age of 2 can [reduce your lifetime risk of breast cancer almost 10%](http://www.ncbi.nlm.nih.gov/pubmed/12133652). That is prevention and will actually save lives. Widening the screening net will cost money and will potentially do more harm than good. It’s not popular to say it, but screening programmes are population based and have to be designed in order to benefit the population, not the individual. ---
**Author:** ![Dangerosa](https://avatars.discourse-cdn.com/v4/letter/d/22d042/32.png) [@Dangerosa](https://boards.straightdope.com/u/Dangerosa)\ **Post date:** [November 20, 2009, 1:18pm UTC](https://boards.straightdope.com/t/no-mammograms-until-50/518024/74 "2009-11-20T13:18:05Z")
Ah, the breastfeeding thing. My sister probably got to stage II because she was breastfeeding. Breastfeeding is a double edged sword - it prevents cancer, but the changes in the breast make it difficult to detect a tumor while its there. Breastfeeding only works if you have children to breastfeed - my cousin, a highly religious woman who does not drink at all (and never has) and worked as a fitness instructor for years (she’s also never had an extra pound on her in her life) is infertile. Her only risk factor was her mother’s cancer - but no gene exists in our family. Again, individuals are not populations. ---
**Author:** ![handsomeharry](https://avatars.discourse-cdn.com/v4/letter/h/e9c0ed/32.png) [@handsomeharry](https://boards.straightdope.com/u/handsomeharry)\ **Post date:** [November 21, 2009, 7:41pm UTC](https://boards.straightdope.com/t/no-mammograms-until-50/518024/75 "2009-11-21T19:41:06Z")
> [@StGermain](#): > > As the sister, daughter and niece of women who’ve had breast cancer, I think this is assinine. In the end, it’ll be used by insurance companies to refuse to pay for screening mammograms. Presumably, since I’ve had them since my late 30’s (whatever happened to the concept of a baseline mammogram early on - are those no longer recommended, too?) and often then have to have diagnostic mammograms every 6 months or so, I’ll still be covered. > > My worry is if fewer mammograms are performed, the technology to refine the images and improve technology will slow down. > > This taskforce might not be a pawn of the insurance companies, but you can be sure the recommendations put forth will be given a great deal of weight, especially whe it will save both the insurance companies and Medicare/Medicaid money. > > StG It’s funny that you thought that the task force was the tool of the insurance industry. I thought that it was a tool of the administration. It harkened back to one of the Clinton’s plan of the early nineties, that mammograms would be done every five years. hh ---
**Author:** ![gonzomax](https://avatars.discourse-cdn.com/v4/letter/g/e8c25b/32.png) [@gonzomax](https://boards.straightdope.com/u/gonzomax)\ **Post date:** [November 22, 2009, 3:15am UTC](https://boards.straightdope.com/t/no-mammograms-until-50/518024/76 "2009-11-22T03:15:33Z")
The panel was set up by Bush. I don’t think they made a financial or political decision. In America we test a lot more than other countries. Perhaps too young and too often. We get a lot of false positives and needless procedures. What way would you accept dealing with that problem? it is a problem also because the density of breast tissue on younger women makes the test less reliable. We waste a lot of money and scare a lot of women. ---
**Author:** ![Markxxx](https://avatars.discourse-cdn.com/v4/letter/m/5daacb/32.png) [@Markxxx](https://boards.straightdope.com/u/Markxxx)\ **Post date:** [November 22, 2009, 9:52am UTC](https://boards.straightdope.com/t/no-mammograms-until-50/518024/77 "2009-11-22T09:52:22Z")
It reminds me of a line from the old _Burns and Allen_ radio show, the episodes where Gracie is running for president. This was 1940 and there was a slogan “A chicken in every pot and a car in every garage” Gracie says" _Now a chicken in every pot and a car in every garage sounds like a wonderful thing, unless you happen to be the chicken_ And in someways this is applicable. If you are one of the few who’s life is saved by early testing, the results of this study are not only insulting but deadly. ---
**Author:** ![KarlGrenze](https://avatars.discourse-cdn.com/v4/letter/k/dbc845/32.png) [@KarlGrenze](https://boards.straightdope.com/u/KarlGrenze)\ **Post date:** [November 22, 2009, 12:54pm UTC](https://boards.straightdope.com/t/no-mammograms-until-50/518024/78 "2009-11-22T12:54:32Z")
Apologies if this reads a bit confusing: I wonder if they’ve done some studies (retrospective) that show the percentage of each type of mammary cancer diagnosed in women 40-49 (the disputed age). And then, of those that they’ve found, which one of them are known to have an aggressive course and which ones are more indolent, and hence would’ve been found quietly at the first mammogram at 50. Of those indolents, would finding them earlier alter their treatment options (ie, it will be a more aggressive treatment at 50 than at a younger age). Of those that are aggressive, if they’ve done a study that shows that earlier screening does not, overall, alter prognosis (treatment remains the same, life expectancy idem). It seems to me they’ve been done, but they haven’t been put forward. Would be nice if they could at least be referenced in this thread (_hint, hint_). Sorry, but my PubMed-fu is weak and restricted to animals. 😉 ---
**Author:** ![DoctorJ](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/doctorj/32/2904_2.png) [@DoctorJ](https://boards.straightdope.com/u/DoctorJ)\ **Post date:** [November 22, 2009, 1:36pm UTC](https://boards.straightdope.com/t/no-mammograms-until-50/518024/79 "2009-11-22T13:36:26Z")
Just after I started practicing I sent a patient for a CT scan which found an incidental adrenal tumor. It was almost certainly nothing to worry about, but it required some simple urine tests and a follow-up scan a few months later, so I sat down and told him about it. To say he freaked out is a giant understatement. My nurse and I spent the next 30 minutes trying to explain to this previously reasonable, intelligent man that the tumor was almost certainly benign, and he finally seemed to calm down enough to go home and start his urine collection. Later that night he shot himself in the head. So there are absolutely consequences to telling someone you need to do further tests to rule out cancer. A reaction that severe is rare, of course, but we’re talking about small numbers anyway. The positive predictive value of mammography (that is, the percentage of people with positive mammos who actually have a malignancy) in 40-49 year olds appears to be around 2%. And mortality among those with malignancy is reduced by 15% with annual mammograms. Put these two numbers together, and 3 out of 1000 people who have positive tests actually benefit from it. So even though complications of testing that lead to death are rare, there don’t have to be many of them to make the whole thing a wash. And you don’t just compare deaths to deaths, either–some people might have massive fits of depression, some people might lose their breasts unnecessarily, some people might get severe but nonfatal infections from the surgery or needle biopsy, etc. It’s hard to compare nonfatal complications to deaths, but epidemiologists have ways to do it. It isn’t as simple as “do test, find cancer, save life”. It’s way, way more complicated than that. ---
**Author:** ![DoctorJ](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/doctorj/32/2904_2.png) [@DoctorJ](https://boards.straightdope.com/u/DoctorJ)\ **Post date:** [November 22, 2009, 1:52pm UTC](https://boards.straightdope.com/t/no-mammograms-until-50/518024/80 "2009-11-22T13:52:35Z")
> [@gonzomax](#): > > The panel was set up by Bush. I don’t think they made a financial or political decision. The USPSTF has been around since 1984 in one form or another, and in its current form since 1998. They are, by far, the most objective source out there for screening recommendations. This change is a good example, since they’ve managed to very predictably piss everybody off with it and they made it anyway. [Previous page](https://boards.straightdope.com/t/no-mammograms-until-50/518024.md?page=3) [Next page](https://boards.straightdope.com/t/no-mammograms-until-50/518024.md?page=5)