January 13, 2010

The Benefits and Harms of Mammography ScreeningUnderstanding the Trade-offs

Author Affiliations

Author Affiliations: VA Outcomes Group, White River Junction, Vermont, and the Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire.

JAMA. 2010;303(2):164-165. doi:10.1001/jama.2009.2007

Intuitively, cancer screening makes good sense—find cancers early and treat them before they become dangerous. The intensely negative response to the US Preventive Services Task Force (USPSTF) recommendations about mammography,1 that women with their physicians might decide to screen later or less often, is not very surprising.

For years, physicians and patients have received a simple message about cancer screening, “Take the test not the chance.” The media, celebrities, politicians, advocacy groups, physician report cards (eg, HEDIS—Healthcare Effectiveness Data and Information Set), even US Postal Service stamps reinforce this message. And the public has embraced it. In a national survey of 500 US adults, 87% said they thought screening was almost always a good idea and most indicated they would overrule a physician who recommended against screening.2 Enthusiasm was so strong that for many individuals, screening was not a decision but a moral imperative; one-third thought an 80-year-old who chose not to have a Papanicolaou test, mammogram, prostate-specific antigen screening, or colonoscopy was irresponsible.

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