Breast Cancer Screening: When the Evidence Scares Us
Nurses are big proponents of evidence-based practice. Nurses are working hard to move away from "this is how it's always been done," or "I had a patient once who had a reaction to that treatment so I don't do it."
A big part of looking at evidence is numbers. Nurses need to question whether something can be considered evidence based on the sample size or if predicted outcomes are small or inconsistent. As well they must scrutinize where the study came from - do the authors or their supporters stand to gain or lose based on conclusions drawn from the studies.
Makes sense. But when it comes to cancer, especially breast cancer, it is difficult to consider evidence that goes against "what's always been done."
Logic vs. Emotion
I believe our healthcare system needs to change (I don't want to use the "R" word). I think we are too quick to do expensive tests, invasive procedures and prescribe pills. I believe in prevention and personal responsibility. I also believe in science and that decisions that impact the masses should be made based on good science and evidence.
When I heard the new recommendations for PSA testing this summer and mammography this week, I was, and still am, hesitant to accept.
Every Mother's Day and Father's Day I do road races that raise money to support breast and prostate cancer awareness. I have a personal connection to both cancers. I know breast cancer survivors who were diagnosed well before age 50. I don't know that I want to forego my annual mammogram - even if evidence tells me the exam is unnecessary.
It would be easy for me to listen to the hospitals, radiologists, labs and other groups who are speaking out against the new recommendation because they seem to have our best interests in mind. But I can't forget these entities also stand to lose a significant amount of money - just like the insurance companies stand gain - with the change.
Hype & Health
The most difficult part of assessing information like this is the hype put forth by the media and those with political interests. It's difficult to look logically at any study when being barraged with personal stories of mothers, sisters and daughters being diagnosed with breast cancer at a young age. Do the recommendations really say women younger than 50 aren't worth the cost of a mammogram? Using the same logic, then, what about the 30 year olds and 20 year olds? If we don't test everybody for everything are we saying they are not worth it?
The only conclusion I've come to based on what's happened since the announcement is that I don't trust any source to give me pure logic and science. This announcement has only served to confuse and to fuel the current political strife. I wonder if anybody has our best interests in mind.
For more on this topic, read these additional blogs: Mammography Screening Changing? and Mammagrphy and the Right to Choose