Has effective cancer screening with earlier detection of lower stage disease become too effective with patients disregarding revised screening guidelines. While in screening one casts a wide net to catch as much as possible, there may be "false positives" or increased benign disease being overtreated?
Are we victims of our own success? PSA screening has also come under increased scrutiny as well and we recognize we may be overtreating small, low grade, clinically indolent prostate cancers. As more data comes out about more successful predictions of biological behavior and risk profiles, radiology and pathology may see less mammograms, pap smears and prostate biopsies. Ditto for screening colonoscopies (invasive and virtual).
With pap smears, for example, we recognize that there may be some women who are "overdiagnosed" with atypical cells or even low grade dysplasia that may be of little clinical significance but we also know that few high grade precursor lesions or invasive cancers are missed in patients who get appropriate examinations, screening and follow-up.
Has public health oversold one's risk and the utility of screening?
I was a bit surprised about the ACOG coming out with the new pap smear modifications. I have heard gynecologists mention that the yearly pap visit affords an opportunity for younger women the opportunity to see a physician which may be the only time to do so outside of pregnancies and get a physical exam, blood pressure check, routine labs, etc…
No doubt the fear of "health care reform" and insuring another 40 milion people or so forces public health organizations to look at cost:benefit ratios to maintain costs while meeting appropriate outcomes.
According to a USA Today/Gallup poll, "a vast majority of American women plan to ignore controversial new recommendations about mammograms," USA Today (11/24, Szabo) reports. "The poll also shows that most women sharply overestimate their risk of developing the disease." The survey of 1,136 women found that 76% "say they disagree or strongly disagree with the recommendations. And 84% of women ages 35 to 49 say they plan to get mammograms before age 50 despite the independent panel's advice." Meanwhile, "Women also perceive their breast cancer risk to be higher than it really is. Forty percent of women estimate that a 40-year-old's chance of developing breast cancer over the next decade is 20% to 50%. The real risk is 1.4%, according to the National Cancer Institute."
The Los Angeles Times (11/24, Adams) recounts the recent mammography guidelines controversy, noting that "somewhat lost in the fracas is the fact that the task force was not suggesting all women under 50 eschew mammograms: The recommendations did not apply to women at high risk for breast cancer." The Times analyzes statistics and risks surrounding breast cancer and mammography, before asking, "If doctors can't make up their minds about screening, how can women? Some doctors say they will take advantage of the current dust-up to have careful conversations with their patients about the risks and benefits of screening in the context of patients' own risk profiles."
The Washington Post (11/24) also analyzes the controversy surrounding the US Preventive Services Task Force's recommendations in a Q&A with Kay Dickersin, director of the US Cochrane Center and the Center for Clinical Trials at the Johns Hopkins Bloomberg School of Public Health. Dickersin said that the recommendations are "well thought out," explaining the task force's methodology and noting that "all the models showed about the same thing even though they used different assumptions — screening every other year saves just as many lives but does less harm."