The news this week is about new guidelines for cancer screening. These guidelines are based on so-called evidence based medicine. This approach looks at not only lives saved but at the unnecessary or false positive results that leads to complications, anxiety and increased medical cost. It asks the question if the lives saved are really worth it. The panel of folks who developed the new guidelines didn’t have any real experts in the field to give their input. The new guidelines call for the start of mammography screening at age 50 rather than 40 and also state that women do not need to do self-examination. Experts in the field say that the new guidelines are wrong at that many lives are saved by the start of mammography screening and self-breast examination at age 40. My own experience which dates back to the literal start of mammography by Egan in the 1960’s also tells me that the guidelines will cost lives. I have personally detected many cancers under age 50 and these women are alive because of early detection. It is true that false positive results cause anxiety and are costly but it is a small price to pay for the lives saved.
The guidelines say that only 1 life out of every 1,904 screened will be saved whereas if you wait until 50 to start screening it is 1 life saved for every 1,300 screened and over 60 it is 1 life saved out of 500 screened. In other words it’s not worth saving the 1 out of 1,904.
With this statistical approach we could look at the airlines. There will be a couple of million people flying on Thanksgiving. Using the same number as the screening guidelines this would mean about 1,054 would die from flying this Thanksgiving. With this number the airlines would be closed and millions of dollars would be spent to protect that number and save the lives. I don’t know why we are spending so many billions of dollars on screening for terrorist who might board the airlines. We should eliminate this costly and inconvenient practice because the terrorist would probably only crash 2 or 4 airplanes a year. If we lost only a few thousand passengers a year this is still less that the projected loss from discontinuing the practice of screening mammography under age 50.
The government is going to love these new guidelines and with national healthcare we can expect many more recommendations of this nature. If we look at evidence-based medicine carefully we could eliminate about 80% of visits to the doctor each day and that would even save lives. Many more lives could be saved by eliminating tobacco and alcohol from the market and reducing the speed limit to 55 mph.
It’s not so bad being old and sitting on the porch. My spouse and I have already had everything and there is nothing left to screen for. We are just waiting our turn for the government panel that evaluates you at the end of life and will stamp my forehead with the do not resuscitate label.