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Tuesday, 22 November 2011

Breast Cancer Screening Recommendations - when science and passion collide

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Many of us scratch our heads at our neighbours who refuse immunization despite "expert interpretation" of the scientific evidence, continue to smoke in the face of illness or indulge in unhealthy foods while still knowing the consequences.   No doubt you could provide many examples of attitudes and behaviours that defy the public health practitioners logic.
Along come new recommendations on breast cancer screening based on evidence Breast Cancer screening recommendations . These recommendaations are from the Canadian Task Force on Preventative Health Care.  This is a reincarnated group that all health practitioners should look to for guidance on preventative activities http://www.canadiantaskforce.ca/index.html. The efforts of the task force are an extension of activities that have been undertaken in Canada since the 70’s. 
The current iteration of the task force reaffirms the recommendation to not do mammography screening on low risk women age 40-49 and are now reversing recommendations on clinical and self examination of the breast such that these are no longer recommended to be advised or routinely performed.  There are recommendations on when mammography is highly recommended for women 50-74.
I have faith in the scientific review process that has prompted this high powered group in reviewing the literature to conclude as they have, even if they are light on the population epidemiology skill set.   The challenge that will arise is the outcry of passionate health devotees that perceive that they are being deprived of access to what they value as a needed health intervention.  This is the diametrically opposed end of the spectrum of those disbelievers that challenge the evidence to avoid engaging in health improving activities – this equally robust group of individuals will dismiss the proposed recommendations, claim that they are being denied access to medical services, and undermine the credibility of the task force’s actions.  Similar, but perhaps less strident responses occurred to the US counterpart’s recommendation against prostate cancer screening released last month http://www.uspreventiveservicestaskforce.org/uspstf12/prostate/prostateart.htm .
The challenge here, is that the committee was disbanded for 4 years and this is their first set of recommendations.  Coming forth with recommendations that may be science based, but lack the public (and some professional) alignment undermines their potential great efforts.  Perhaps there are some suggestions on the need for public consultation, transparent peer review processes and generally building support for modifying those sorts of recommendations that are likely to result in condemnation by public opinion leading groups.  The process is a great one and very valuable to the health community.  It needs to be remembered that science is only one aspect of public policy development.

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