Good public health: 1 part science, 1 part education

The panel that suggested women in their 40s don't really need mammograms is said to be astonished at the public reaction, as the New York Times reports. Maybe the most astonishing thing is that these experts were surprised. Where do they live, Mars?

An effective public-health message consists of two parts, equally important: solid science and a well-managed public education campaign.

When the U.S. Preventive Services Task Force issued its suggested changes to breast-screening guidelines on Monday -- saying that women who don't have particular risk factors for breast cancer would be better off waiting until age 50 to start mammograms, and saying that self-exams haven't been shown to make a statistical difference in survival -- it may have displayed solid science but clueless management of the message.

And by the way, the task force is made up of doctors from the private sector, mostly from academia. And most deliciously ironic of all, the current members were appointed by the former President, a Republican. Kathleen Sibelius, secretary of the Department of Health and Human Services, wasted no time pointing that out.

The Agency for Healthcare Research & Quality, which actually released the task force recommendation, should have laid some groundwork beforehand. It would have taken months of education to bring the public up to date on the science.

And let's face it, no one is in the mood right now to study the meta-analysis published in the Annals of Internal Medicine along with the release of the guidelines. The public has all it can handle right now trying to ferret out the truth vs. lies in the health-reform debate.

Medical reporters have known for more than a decade that the science doesn't really support mammogram screening for women in their 40s because for most, the tissue hasn't thinned enough to make the mammogram easily readable.  Also, there's been a growing awareness that some breast cancers -- like prostate cancers -- aren't going to be a threat; in fact, some disappear. No one really knows why.

Ideally we need to get better at detecting which cancers are going to be a threat and which aren't. But we aren't there yet.

Meanwhile, the task force displayed great courage but lousy timing. Americans aren't all that fond of science to begin with, and when it seems to conflict with common sense and motherhood and apple pie, well.... put it on hold. 

Lay the groundwork first: with public education.

--Carol Gentry, Editor, can be reached at 727-410-3266 or by e-mail.