Tuesday, November 17, 2009

New Recommendation for Breast Cancer Screening

A new recommendation for breast cancer screening is in the news today.  The key is that mammography is no longer recommended for a woman aged 40-49 who has an average risk of breast cancer.  And, while it has received fewer headlines, a recommendation against teaching women to perform breast self-examinations.

The key result received a grade "C".  This means that "The USPSTF recommends against routinely providing the service. There may be considerations that support providing the service in an individual patient. There is at least moderate certainty that the net benefit is small."  USPSTF stands for United States Preventive Serivces Task Force.  Definitions of the grades of recommendations can be found here.

So what might a small net benefit mean?  It might be economic, although the USPSTF rarely makes economics a major consideration.  More directly, the USPSTF weighs benefits versus harms.  And the harms are from the potential for overtreatment.  Overtreatment also has potential high monetary costs. 

The interesting thing is that a recommendation remains to allow individual women and providers to decide whether an individual woman needs it.  This decision is supposed to be driven by clinical considerations.  What will be interesting to watch is whether payers change the incentives to receive mammography covered by insurance.  If insurance coverage is withdrawn except when there is a strict clinical justification, will women continue to get mammograms they have to pay for out of pocket.  It depends on how risk averse they are and how tight their budgets are.  It will be important to observe the changes in utilization over the next several years and to analyze how this affect women's health.

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