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medpundit |
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Tuesday, September 03, 2002The USPSTF is the government body that makes evidence-based recommendations on how preventive medicine should be practiced. Insurance companies and the government use their recommendations to monitor the quality of a physician’s practice. I routinely recieve notices from insurance companies informing me which of my patients, beginning at age 40 have failed to get their mammograms. The problem is, that all evidence is not created equal. The USPSTF data are based on a “metanalysis” of other studies, a practice which involves taking all the data from other research and mixing it in a statistical soup. The problem with this approach, is that published research tends to be biased toward studies that show a postive effect of treatment, so the combined analysis can be stacked toward treatment or, in this case screening. The other problem is that it can exaggerate the findings of a collection of poorly designed or border-line adequate studies by grouping them all together. It's one of the murkiest ways to come to conclusions about a test or a treatment, and not all that reliable. The Canadian study is the better and more reliable research. It looked at 25,214 women who had mammograms every one to two years, and 25,214 women who didn’t, ages 40 to 50 and followed them for eleven years. There were 105 breast cancer deaths in the mammography group and 108 in the non-mammography group. Essentially no difference. Yet, the controversy continues, and it probably will for some time, at least in this country. Breast cancer and mammograms have become so politicized here that decisions about it unfortunately tend to be made with the heart, not the head. For summaries of the two studies click here and here. This portion of the USPSTF summary is particularly apt: As better studies become available, recommendations about breast cancer screening may change. Looks like those better studies are already here. posted by Sydney on 9/03/2002 06:42:00 AM 0 comments 0 Comments: |
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