A couple of years ago, in a bellwether for how hard it’s going to be to ever seriously rein in healthcare costs, there was an instant and thunderous backlash against a new recommendation that women with no risk factors put off routine mammograms until age 50. A small number of famous breast cancer survivors who had been diagnosed at a young age took immediately to the airwaves, and that was all she wrote. Within 48 hours, HHS Secretary Kathleen Sebelius had disowned her own task force and assured the nation that absolutely nothing would change.
Now the same group that made the mammogram recommendation is back:
The U.S. Preventive Services Task Force, which triggered a firestorm of controversy in 2009 when it raised questions about routine mammography for breast cancer, will propose downgrading its recommendations for prostate-specific antigen (PSA) for prostate cancer onTuesday, wading into what is perhaps the most contentious and important issue in men’s health.
….“The harms studies showed that significant numbers of men — on the order of 20 to 30 percent — have very significant harms,” Moyer, a professor of pediatrics at Baylor College of Medicine, said in a telephone interview Thursday.
There are never any perfect answers to these questions. We could start routinely testing everyone at age 20, and it’s almost certain that at least a few treatable cancers would get screened. At every cutoff point, whether it’s age related or condition related, you have to decide if the cost of tightening the testing criteria outweighs the benefit. What you can’t do is simply decide that cutoffs should never be tightened because, inevitably, there will be a cost. It might be small, but it’s always there. And then the USPSTF becomes a death panel because that’s a handy thing for demagogues to call it.
So we’ll see how this one goes. My previous brush with prostate screening is here.