Leave health care decisions to patient, doctor

As the Senate debates the future of health care in this country, now is the time to decide what the standards will be: the best empirical evidence, or emotion?

The latest case revolves around a recommendation by an advisory group, the United States Preventive Services Task Force, that women delay routine mammograms until age 50 instead of the well-established advice that women start them at 40.

The White House was quick to distance itself from the advice.

Kathleen Sebelius, the Secretary for U.S. Health and Human Services, released a statement that the controversial recommendations would not affect insurance coverage for American women.

"The recommendations have caused a great deal of confusion and worry among women and their families across this country. Our policies remain unchanged. I would be very surprised if any private insurance company changed its mammography coverage decisions as a result of this action."

Admittedly, the task force, comprising 16 "private-sector experts in prevention and primary care" does not include any oncologists, but it did call on the input of a team of four oncologists, a cancer surgeon and a cancer researcher. The cancer experts did not decide what screening is appropriate, but presented the evidence to the task force, which made the final decision.

The recommendation is a judgment call based on the risks vs. benefits of mammograms beyond at 40, but the task force does say "the decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms."

A similar firestorm was ignited last spring when two studies, taken together, showed that the PSA test for prostate cancer does not decrease mortality from that disease.

While the Pap test for cervical cancer and fecal occult blood tests for colorectal have been proven to decrease mortality from those cancers, others are less clear. Some cancers are so slow growing they can be defeated even if caught late; others so fast that it's too late with even early detection. One study even found that about one quarter of breast cancers detected early on mammograms vanish spontaneously.

So what's the answer?

Health care decisions based on the best statistical evidence are not likely to be the most popular, but testing standards shouldn't be based on the disease or constituency with the most political clout.

But there are risks and benefits to any medical procedure, and the final decision must remain with the doctor and patient, not some actuarial table.