What are you being taught regarding mammography?

[bashir]

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http://well.blogs.nytimes.com/2012/11/28/ignoring-the-science-on-mammograms/

We haven't done OB/GYN yet, but I'm curious how my school will present the current science regarding the efficacy of routine mammography screening, even at the reduced frequency now recommended by the USPSTF. Everything I've read has led me to believe that mammography is about on the level of PSA screening--not worth it in the absence of a known genetic predisposition or family history of the condition. At this point I would not advise my mother, who is over 50, to bother with them, but it seems like flouting official preventive care guidelines has the potential to get you into a lot of trouble, and possibly upset patients as well.

So I'm wondering, what have you guys been taught in school? What conclusions have you come to on your own? What do you plan to do when you believe preventive care guidelines are lagging behind the science on a particular screening test?

 

[ArcGurren]

The USPSTF came to exactly the opposite conclusion via a meta-analysis of the available data

http://www.uspreventiveservicestaskforce.org/uspstf09/breastcancer/brcanup.htm

The evidence for the efficacy of PSA is much much much lower than the evidence that screening mammography/diagnostic mammography helps detect possibly breast cancer at an earlier stage.

 

[link2swim06]

http://well.blogs.nytimes.com/2012/11/28/ignoring-the-science-on-mammograms/

We haven't done OB/GYN yet, but I'm curious how my school will present the current science regarding the efficacy of routine mammography screening, even at the reduced frequency now recommended by the USPSTF. Everything I've read has led me to believe that mammography is about on the level of PSA screening--not worth it in the absence of a known genetic predisposition or family history of the condition. At this point I would not advise my mother, who is over 50, to bother with them, but it seems like flouting official preventive care guidelines has the potential to get you into a lot of trouble, and possibly upset patients as well.

So I'm wondering, what have you guys been taught in school? What conclusions have you come to on your own? What do you plan to do when you believe preventive care guidelines are lagging behind the science on a particular screening test?

I trust the USPSTF much more. ACOG comes to some weird conclusions on many issues.

Example, who here has read the study which all the cautions about hormone replacement originated from? It is nothing short of ACOG cherry picking data as they wish.

But regarding mammograms, most ob/gyn try to take the guidelines and then modify to each individual patient.

I'd advise you to find the most recent data, read it straight from the articles, and decide for yourself.

 

[Rendar5]

The USPSTF came to exactly the opposite conclusion via a meta-analysis of the available data

http://www.uspreventiveservicestaskforce.org/uspstf09/breastcancer/brcanup.htm

The evidence for the efficacy of PSA is much much much lower than the evidence that screening mammography/diagnostic mammography helps detect possibly breast cancer at an earlier stage.

Not sure they actually came to an opposite conclusion. they came to a conclusion of barely statistically significant benefits with NNT's in the thousands for all but one age group, after grouping several trials

 

[Kevin Baker]

We haven't gotten to mammography yet but we did prostate and were told to screen PSA in all males after age 50, and high risk males after age 40-45, so I have to assume mammography will be presented in a similar way.

My own conclusions, for both PSA and mammograms, is we need to stop using them as population screening tools and start using them as screening tools only on those whose history or lifestyle increases risk. Simply using age or race to limit who gets screened is lazy and we can be a lot more specific by including other variables such as tobacco use, where they live, pollution in the area, family hx, etc.

 

[Bacchus]

Its still common practice to begin mammography at 40 yo. There hasn't been a large convergence yet, as far as I've seen, to delay until 50.

 

[Kaustikos]

The data suggests not getting mammograms because of the false positives from screens due to - blah blah blah things - until at least 50 years of age. The high incidence of false positives (60%) for 40-49 means it's just not worth it.

 

[link2swim06]

Its still common practice to begin mammography at 40 yo. There hasn't been a large convergence yet, as far as I've seen, to delay until 50.

I have a feeling this might be more about money than medicine.

Mammography centers don't want to lose 1/5 of their patients.