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About the Site:

This is the blog for the book Medical Decision Making: A Physician's Guide, by Alan Schwartz and George Bergus (Cambridge University Press, 2008). The book is now available from Cambridge University Press

About the Authors:

Alan Schwartz, Ph.D. is an Associate Professor of Medical Education and Pediatrics at the University of Illinois at Chicago College of Medicine, where he teaches and conducts research on physician and patient decision making.

George Bergus, M.D., M.A. is the Dr. William and Sondra Myers Family Professor of Family Medicine at the University of Iowa Carver College of Medicine, and Co-Director of the Family Practice/Psychiatry Residency program. He holds a Certificate of Additional Qualification in Geriatrics.

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Mammography and decision making

November 29th, 2009 by Alan Schwartz

A little history for the non-US readers: the U.S. Preventive Services Task Force (USPSTF) is an independent panel that reviews evidence and issues recommendations for preventive health care services.  They are sponsored by the U.S. Agency for Healthcare Research and Quality (AHRQ) but the panelists are physicians, nurses, and public health researchers  employed by universities and state health departments.

From 1989-2002, annual screening mammography was recommended for women at low risk of breast cancer starting at age 50 in the US. In 2002, USPSTF changed that recommendation to recommend mammography every 1-2 years for women starting at age 40. This change was scientifically contentious – there were questions about the data – but endorsed by cancer organizations. This month, USPSTF changed the recommendation back to starting at age 50. You can read the published recommendation here. This change is less scientifically contentious, but has been even more upsetting to cancer organizations and, in many cases, to women.

I’m going to tackle just a few of the key decision making questions here to try to clarify what’s going on. For example, I’m going to set aside questions of cost and of insurance coverage, which are significant issues, to focus only on the health questions, and only on women at low risk for breast cancer.
Read the rest of this entry »

Posted in Beyond the individual, Decision Making, Developing information, Understanding uncertainty | No Comments »