A STEP IN THE RIGHT DIRECTION:

Delay routine mammograms until age 50, US panel says (Stephen Smith, 11/16/09, Boston Globe)

The US Preventive Services Task Force, established by the federal government to set standards on disease prevention and primary care, concluded that mammography saves relatively few lives in women 40 to 49, and that this benefit is eclipsed by the risks, including tests that erroneously detect tumors when none exist.

The task force used a similar analysis to determine that women from 50 to 74 -- when breast cancer becomes increasingly common -- should be screened, but that little was gained by performing mammograms on a yearly schedule. The panel also found that breast self-examinations are not useful, at any age. [...]

The mammography revisions come amid an intensifying debate about the merits of cancer screening in general. Screening is based on the notion that finding tumors early, when they are most treatable, saves lives. But many of the cancers identified are slow-growing and non-lethal, critics say, raising the question whether the tests identify enough life-threatening cancers to justify the anxiety and sometimes unnecessary surgeries prompted by inaccurate results; and the financial cost. [...]

[A] Dartmouth researcher who has challenged the reflexive orthodoxy that cancer screening is always desirable hailed the Preventive Services Task Force recommendations.

"Even if you don't care about money, you have to consider the trade-off of benefits to harms, and all screening has harms," said Dr. H. Gilbert Welch, professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice. "The recognition that this is a trade-off has become more broadly understood, and that's a really good thing."