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Lawmakers around the country are rushing to enact laws that require providers to notify women if their screening mammograms find dense breast tissue. Meanwhile, clinicians remain at a loss concerning how to counsel such women.

The post Little progress in how to advise women with dense breasts appeared first on OUPblog.

Robert M. Veatch is Professor of Medical Ethics at The Kennedy Institute of Ethics at Georgetown University.  He received the career distinguished achievement award from Georgetown University in 2005 and has received honorary doctorates from Creighton and Union College.  In his new book, Patient, Heal Thyself: How the “New Medicine” Puts the Patient in Charge, he sheds light on a fundamental change sweeping through the American health care system, a change that puts the patient in charge of treatment to an unprecedented extent. In the original article below, Veatch looks at the recent debate over mammograms.

Controversy has erupted over recommendations of a government-sponsored task force that are widely interpreted as opposing mammography for women ages 40-50 without special risk factors. This reverses an earlier recommendation favoring such screening. In response a number of critics including Bernadine Healy, the form head of the National Institutes of Health, and spokespersons for the American Cancer Society and the American College of Radiation have challenged the recommendation claiming that cutting out the screening will cost people’s lives. They insist that 40-50 year-olds should still be screened routinely.

Strange as it may seem, both of these positions are wrong. Both the defenders of the task force recommendations and the critics make the mistake of assuming that the data from medical science can tell a person what the correct decision is regarding a medical choice such as breast cancer screening. I am a defender of what I call the “new medicine,” the medicine in which it is up to the patient to make the value choices related to her medical treatment. In principle, decisions such as those addressed by the mammography task force and its critics cannot be derived from the facts alone. Each person must evaluate the possible outcomes based on his or her own beliefs and values. This is true not only for areas of obvious value judgment such as abortion and withdrawing life-support during terminal illness, but literally for every medical choice, no matter how mundane.

In the case of mammography screening for breast cancer remarkable agreement exists on the medical facts. Mammography catches cancers that cannot be found by other techniques such as breast self-exam. People’s lives are saved by mammography. The problem is that many more lives can be saved screening older women in part because the incidence of cancer is greater. The task force expresses the benefit in terms of the number of people who would need to be screened to extend one life. For women 40 to 49, 1904 would have to be screened; for women 50-59 only 1339. Thus the absolute risk reduction from screening is greater for the older women. In an article published in last week’s Annals of Internal Medicine alongside the task force report, the same idea is expressed in terms of percentage reduction in breast cancer deaths from screening compared to no screening. For women