Mammograms, poor communication, and politics

Abstract

What lessons have been learnt from the furore in the US over new recommendations on breast screening?

The US Preventive Services Task Force, though appointed and staffed by the government, is an independent, rotating panel of doctors, nurses, and methodologists. Its mission since 1984 has been to systematically review the evidence on clinical preventive services—screening tests, chemoprevention agents, and counselling interventions—and to publish recommendations based on their findings. (Full disclosure: I formerly directed the task force staff and edited its first book in 1989.)

The task force is no stranger to controversy. In order to recommend a given preventive service, its methodology requires good evidence that the benefits exceed the harms. Many of the panel’s early recommendations, when systematic reviews and evidence based recommendations were not widespread, differed from those of established authorities. Disease specific advocacy groups and medical specialty societies were often furious when the task force did not agree with them about the effectiveness of various screening tests for colorectal, prostate, skin, or breast cancer or for lead poisoning or coronary artery disease.