Correction: Mammogram Recommendations

Correction: On November 17 post on mammogram recommendations contained a misstatement. Based on the studies available in 2002, the USPSTF DID recommend in women age 40-49 receive annual mammograms. Since the verification hotlink was not included in the post, the only reasonable explanation for this error was that I had mistakenly viewed the previous recommendations (also found in the 2nd Print Edition of the US Guides) of the Task Force, which agreed with the present recommendations - my apologies. We will make certain the hotlinks are included in future posts. As of November 22, these post have been peer-reviewed by the AOCOPM publications committee, which will hopefully catch any errors prior to posting.


Some medical commentators, such as Bernadine Healy MD, have said that the Task Force is always flip-flopping on their recommendations. However, the Task Force is really looking at the whole body of scientific evidence available to us at a given point in time. Naturally, over time as evidence accumulates and studies are repeated, theories are either verified or disproven. This is why the standard of care for any disease typically does not change with one study. How many health recommendations have changed over the years – such as to use margarine rather than butter, would anyone still make that recommendation today? How is public health any different from any other area of medicine practice?

This mammogram discussion also brings to light the conflicting recommendations as to what constitutes the standard of care in medicine today. The issue is that there are different standards for the same disease across specialties and across the first world. Ironically, the USPSTF is recognized as “the standard” worldwide for making prevention guidelines because of the extensive review of medical research that goes into the process to determine public health guidelines for the general population. The American Cancer Society and other groups are looking at the sub-segment of the population diagnosed with cancer, not the proportion of those people relative to the entire population. Interestingly, no one has mentioned that these groups may have their own political, legal or monetary concerns.

From a public health perspective, if it costs more to screen people to find one case of disease than it does to treat one case of disease (at the average stage it would be found), there is no point in screening. It costs more than it’s worth. [Obviously the individual who may have cancer doesn’t feel that way. But from a societal standpoint, where money is not an unlimited commodity, we must seek the biggest bang for our healthcare buck.] In this case, a better screening test that does not yield a cumulative 43% false-positive rate by the ninth mammogram or a cheaper one to make it worthwhile for this age group.