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.
A recent edition of AJGP (March 2023) suggested changing prostate cancer screening to include asymptomatic men older than age 50. In general, this has never been suggested as a guideline.
My concerns echo yours in the unknown or known additional morbidity and mortality involved in the treatment/ surveillance of those returning positive results.
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.
The organisation that promotes breast screening in Australia is funded by both Federal and State governments - so yes, its taxpayer dollars at work. And the patient advocacy groups are heavily funded by the pharmaceutical industry. There is very little nuance in the discussion from my perspective. It's a mantra - it "saves lives".
Thanks Ditta, I think the more info, the better. I found many different responses from women - some want to test, test, test, no matter the treatments, while others are more comfortable doing less.
I agree, I would not ignore it completely. Any family history or unusual lumps or pain would warrant a check I think. It's a deeply personal issue to women and I would not presume to know what suits each individual.
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.
Yep, its a trade-off and everyone feels differently. I remember doing a story on screening for prostate cancer....same issues arose.
A recent edition of AJGP (March 2023) suggested changing prostate cancer screening to include asymptomatic men older than age 50. In general, this has never been suggested as a guideline.
My concerns echo yours in the unknown or known additional morbidity and mortality involved in the treatment/ surveillance of those returning positive results.
https://www1.racgp.org.au/ajgp/2023/march/prostate-specific-antigen-psa-testing-for-prostate
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.
The organisation that promotes breast screening in Australia is funded by both Federal and State governments - so yes, its taxpayer dollars at work. And the patient advocacy groups are heavily funded by the pharmaceutical industry. There is very little nuance in the discussion from my perspective. It's a mantra - it "saves lives".
This is so useful. Overdiagnosis is dreadful and driven by financial considerations at times.
Thanks Ditta, I think the more info, the better. I found many different responses from women - some want to test, test, test, no matter the treatments, while others are more comfortable doing less.
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.
Certainly in terms of a screening program of healthy women, there will be some women who get treatments that don’t improve their lifespan.….
I'll take a look, thanks.
I agree, I would not ignore it completely. Any family history or unusual lumps or pain would warrant a check I think. It's a deeply personal issue to women and I would not presume to know what suits each individual.