In an invited commentary, Timothy J. Wilt, M.D., M.P.H., and Melissa R. Partin, Ph.D., both of the Minneapolis Veterans Administration for Chronic Disease Outcomes Research and the University of Minnesota, Minneapolis, note that in their study, Welch and Frankel, "express concerns that overly inflated perceptions of the benefits of mammography may lead to a self-perpetuating cycle of unwarranted demand for screening, overdiagnosis, overtreatment, and a continually growing population of breast cancer survivors who advocate mammography. The demographics of survivorship suggest that their concern is legitimate."
"Preventive health care services like cancer screening can result in tremendous individual and public health benefits by identifying disease at early, more treatable stages or lowering a patient's risk of developing a disease altogether," write Wilt and Partin. However, the authors do caution that, "they do not always provide the expected benefit and cause harms such as overdiagnosis and overtreatment."
"Numerous studies have documented that the strongest predictor of mammography utilization is physician recommendation," the authors write. "Therefore, simple, highly effective and accurate messages can come directly from clinicians."
"In conclusion, a simple science-based message can and should be delivered to many individuals considering early disease detection and treatment," the authors note. "The opportunity and challenge for clinicians is to be that reliable source of information that ensures that our patients are able to make well-informed decisions that incorporate the best evidence into their personal values."
(Arch Intern Med. Published online October 24, 2011. doi:10.1001/archinternmed.2011.509. Available pre-embargo to the media at www.jamamedia.org.)
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