January 1, 1970 (Vol. , No. )
Taralyn Tan Ph.D. Curriculum Fellow Harvard Medical
The sea of pink ribbons, water bottles, chocolate bars, and almost any other consumer good one can think of had barely made it off of the shelves when the U.S. Preventive Services Task Force (USPSTF) became the rain cloud that dampened the residual hope and optimism of last year’s breast cancer awareness month. The USPSTF, “the leading independent panel of private-sector experts in prevention and primary care,” according to its sponsoring Agency for Healthcare Research and Quality, released its updated mammography guidelines last November. In its report, the USPSTF recommended against routine screening in women between the ages of 40 to 49 years old, recommended against physicians teaching women how to perform breast self-examinations, and recommended that women between the ages of 50 and 74 seek mammograms every two years.
As many organizations, perhaps most notably the American Cancer Society, recommend annual mammograms beginning at age 40, the USPSTF announcement was immediately met with a backlash from physicians, patients, and others from the community, with many claiming that this was a “huge step backward” in cancer prevention. Even louder than the disgruntled outcries was a collective murmur of confusion – what are we to believe when prominent organizations and task forces present us with conflicting perspectives? Just this month, the Society of Breast Imaging and the American College of Radiology threw their bids into the hat, recommending routine screening at age 40 (with high-risk women starting as early as 30). Growing up, we are told that “two heads are better than one,” but now faced with the quarreling heads of the mammography hydra before us, do we really want dissent and uncertainty?
Well I say that people are complaining, when really they should be rejoicing. For the past few months the mammography guideline controversy has been very negatively portrayed in the media, with the conclusion being much the same as that which I hinted at in the above paragraph: conflicting perspectives yield confusion, and what patients really need is clarity, not ambiguity. Yet, to answer my own question, do we want dissent and uncertainty? Absolutely! You see, for many people who have been passively obeying the uniform recommendations (or who perhaps never really thought about the implications of mammograms at all), the confusion caused by this guideline controversy may very well have sparked some interest where a few months ago there was none. Controversy and dissent are very potent catalysts of inquiry, awakening questions and doubts from their state of dormancy. If only a handful of women start thinking more about their individual plans of breast cancer prevention, or if there are a few more discussions between patient and doctor on the topic, then I would have to declare this controversy a successful development in cancer awareness.
Now without siding with one group or the other, I must emphasize that the true value of this current debate does not necessarily lie in who is correct, but rather how we come to the correct conclusion. For instance, merely pooh-poohing the USPSTF guidelines because they contradict “conventional wisdom”, without reading about the methods of the analysis or analyzing the numbers for yourself, is not only unproductive, it may even be detrimental. How many times throughout the course of medicine have guidelines been changed, due to new studies and data? We cannot expect to continue to hone our system of medical care without at least being willing to critically analyze reports that contradict the precedent. Likewise, it would be unwise to etch the number 50 in your head as the magical year of the mammogram, solely based on the logic that, “Well, they told me so.”
So in the spirit of intellectual inquiry, go exploring. Learn more about the risks and benefits and come to your own conclusion. And the next time a controversy pops up in primetime – be it in medicine, politics, or whatever – be thankful, not resentful, as you will have just been provided with the perfect opportunity to crack your complacency and dig deeper.