New US guidelines propose all women should start screening for breast cancer at age 40 instead of 50, but what does the evidence show?
The value of screening for any disease lies in early detection in those with high risk, as you say.
The benefits of diabetes screening should be in lifestyle improvement, but now means commencing medications.
Similar to lipid screening which should be reserved for those with high risk profiles but now inevitably leads to anyone with even a borderline result being prescribed statins.
Regarding mammography, the "follow the money" principle is more difficult to assess, though Occam's Razor suggests it lies somewhere beneath the new recommendation.
The benefits vs harms of mammography is a reasonable debate to have.
But what I think is weird are the policies that surround this intervention. Not only is it required for insurance to cover it every year or so, but it is heavily incentivized and advertised. I question the appropriateness of incentivizing and advertising ( I wonder if advertisements use tax payer money? ) an intervention that clearly has nuance as to which group of women would have a net benefit.
This is so useful. Overdiagnosis is dreadful and driven by financial considerations at times.
I think there might be another issue as well. Imagine a cancer that becomes detectable at year 0 but doesn't metastasize and kill you 'till year 15.
Imagine treatment doesn't change this disease progression.
Detection and treatment at year 0 will appear to give people 15 years of life but detection and treatment delayed to year 10 only five yrs.
It's only when you measure all cause mortality in a population that this lack of efficacy shows up.
I'd be interested in your comments.