The uproar over new breast cancer screening guidelines in the United States underscores the delicate balance scientists and health policy experts face in trying to convince a wary American public that less healthcare, in some cases, may be good for them. The sweeping new guidelines released on Monday advise against routine mammograms for women in their 40s, and suggest women 50 to 74 only get a mammogram every other year instead of yearly. US breast cancer experts and advocacy groups immediately rebelled against the recommendations, saying they endangered women's lives. Some critics said the guidelines were motivated by a desire to ration healthcare – echoing a charge made by Republican lawmakers in attacking healthcare overhaul legislation Democrats are pushing in the US Congress. Democrats say they want to cut healthcare costs and extend coverage to millions lacking health insurance, while their critics say the overhaul would give the government a larger role in people's health. The guidelines, issued by the US Preventive Services Task Force, an influential panel of independent experts, were intended to balance the benefits of saving lives with the harms of false alarms and the cost and trouble of extra tests. “The public has been programmed to believe that doing more is better – more screening, testing, treating – and repeatedly we find gaps in our knowledge about making the linkage between more and better,” said Dr. Harlan Krumholz of Yale University in New Haven, Connecticut. “It seems people are not ready to have recommendations based on evidence. And politics so easily perverts efforts to bring some sense to our use of tests and procedures,” he said. “The burden of proof for doing something should be on the intervention,” Krumholz said. “We are too often assuming benefits that have no basis in fact. Medical care should be guided by good science.” Guidelines appear callous to some But some doctors said the new breast cancer guidelines that focus strictly on science and evidence appear callous and unfeeling, especially to American doctors and patients who have trouble overcoming the intuitive belief in repeated screening. Cynthia Ryan, an English professor at the University of Alabama at Birmingham who studies how breast cancer is portrayed in the media, said such an abrupt change follows years of aggressive communication campaigns. “Everyone knows someone who has had breast cancer,” said Ryan, who has survived two different breast cancers. She said the new guidelines feel like a huge step backward to a generation of women who have been told they can save their lives if they do self breast exams and are vigilant about getting yearly mammograms. “We're emotional because we're so damn confused,” Ryan said. Dr. Kyle Hogarth, who directs a lung cancer risk clinic at the University of Chicago School of Medicine, said there are no official guidelines for lung cancer screening. “The argument against screening for lung cancer has been that when you start to order CAT scans on smokers, you find all kinds of nodules. Only a very small percentage will be malignant,” Hogarth said. He said guidelines need to balance the effectiveness of the screening with the rates of false positives. “If I told you that you had a nodule on your lungs, are you going to be sleeping well for the next couple of months?” But only 15 percent of patients with lung cancer survive. When a women is diagnosed with an early breast cancer, she has a very good chance of survival. Hogarth said breast cancer is a special case. “When you have a disease that has a strong advocacy base and you are saying on a surface that the mantra is changing, you can guarantee there is a push-back,” Hogarth said. “That also factors into guidelines, even though everyone would like to think it doesn't. Politics is everything.”
