Tell Me, Did We Just Get Punked?
Just the other day, my colleague and I were talking about certain drugs we used to use for patients in the ICU. These were drugs that had no evidence of really making a difference, but more or less, drugs that we pumped into a patient in a sort of Hail Mary pass. This exchange was part of a broader discussion of being grateful that we work in a more modern environment of evidence based medicine where clinicians prefer proof (evidence) that drugs (or treatments) work the way we're told they will before we use them. I can tell you that in 25 years of nursing, I've given medications that were ordered by the doctor only because that's the way it's always been done, and I've given medications because studies have proven those drugs to work for the condition being treated. I much prefer the latter.
In the news this week is the controversial recommendation regarding breast cancer screening that is based on a computer model. I'm a bit shocked at the outcomes of this new study that recommends no routine screening until after the age of 50. And no self breast exam? Are you kidding me? I personally know of 3 women who found their own cancers with their very own hands. I personally know 5 women under the age of 50 who have breast cancer--one of whom had a negative mammogram, but a positive breast coil MRI she had to fight to get insurance approval to have. She was in her mid-thirties at the time of diagnosis and the only thing that bothered her was a pain in her breast.
Do these computer models really provide the evidence that doctors need to make intelligent and informed decisions about what tests they order? Do the statistics that show improved outcomes for those diagnosed early even matter? How about the decline in deaths for women in their 40s because they got screened early? Does that count? The new recommendations state that women with a high risk history should have early mammography, but how about the 75% of women who have no history to speak of, but have breast cancer none the less? Should they wait until their disease is so advanced, the only available treatment will be hospice at the time of diagnosis? Don't think this doesn't (still) happen all the time. It does, and I really don't want to see it happen more.
How many radiologists specializing in mammography screening sat on the panel that came up with these new suggestions? It's a trick question, because a wise person would guess that at least one of them was a specialist in this field, right?
Here is the American Cancer Society response to the recent recommendations.