Controversy over breast cancer screening

>>> in today's "spin doctor."

>>> hello, everyone. welcome. i'm dr. nancy snyderman . breast cancer , the number two killer of women in america and has been drill under to our heads to get screened early, that is until today. new guidelines advising women ages 40 to 49 not to get routine mammography unless they are at risk for breast cancer . instead, screening recommendations now to start at the age of 50 and then every two years until the age of 74. with women , ages 60 to 69, those at the highest risk group because of their age, they're most likely to see the biggest benefit. but these are changes that are meeting a fierce debate. susan , let me start with you. big headlines all over the country today about changing recommendations for screening mammography. are these recommendations on target or off target?

>> i think they're on target. they really bring us into line with the rest of the world . they bring nus to line with the scientific data. we have been doing mammography in younger women really based on wishful thinking and hoping that it is going to work and the evidence is that the risks are higher than the benefits in the younger women . i think it's about time that we actually change the guidelines to reflect that.

>> len, the american cancer society has been adamant that you're going to stick with the screening for the 40-year-old age group . you along with american college of radiology and a couple groups that are sticking with the new idea, that is the national breast cancer coalition , the national cancer institute said they're going to reevaluate their suggestions, breast cancer action , national women 's health network. why are you hesitant to embrace these new recommendations?

>> well, nancy, i don't know that i would say we're hesitant. by the way, many groups, many well-reflected professional groups that agree we should not change our approach and certainly a topic of discussion among scientists and experts for some time to come. no doubt about that. we have looked that evidence and looked that same evidence as the task force and we have come to the conclusion that the science does back up screening beginning at the age of 40 and, in particularly, that 40 to 49 age group . the reality is that breast cancer deaths, since 1990 , according to that same study have declined over 3% per year since 1990 in women aged 40 to 49. we don't think the evidence is sufficient to change our recommendation at this time based on the success we had in screening women to this point.

>> susan ?

>> but, actually, a lot of that decrease of deaths is not from mammography screening, but from chemotherapy and better treatments and you can't claim that for mammography. if you look at the randomized studies, you have to follow women for 10 to 12 years to see any benefit and by then they're in their 50s. the problem is, these mammograms in young women are not freebies. there's an increase in false negatives and an increase in false negatives and radiation risk of the mammography cuative cumatively and it's a wash. the benefits really don't outweigh the risks when you look at it as a public policy issue. and i think for us to be continuing to recommend something, instead of finding something that really works better, is really not, not right.

>> len, i think one thing that has come up repeatedly this morning we seem to have anecdotes and new science . any time we have a seismic shift in the message, i have been one of the people telling people to get screened early. i'm part of that big message until now but any time we have a seismic shift, hard to accept a new reality. is that the trouble here or do you really think the data is that flawed?

>> let's be clear here. all of us want to do the right thing for women and all of us want to look at the signs. experts can look at the same signs and come to the same conclusion. the same science is a computer model and the reality is when you look at the data coming out of that model, coming into the model and out of that model, serious concerns whether you can take a computer model to tell us how to treat millions of women . and we're not comfortable --

>> oh, come on.

>> no, i'm very serious about that. i want you to share with me.

>> no, but the data, but the data that the computer model . what they've done, they've taken datas from large randomized controlled trials that have been lots in good studies that we all agree upon and they're just using that to try different scenarios to see where the risk benefit actually pans out. so --

>> not so simple, though.

>> the computer model is the exact right way to do that.

>> not so simple. each one of those models is designed differently and different inputs and each model has different outputs and took all that data and let me share one additional thought.

>> that's the strength of it. they all came out with the same conclusion.

>> they did not come out with the same conclusion and same data. let me share something else with you. very bright people have done computer models particularly in the financial world. they thought they could predict reality and look at the mess that we're in because of that. when you accept this computer model , let me finish here, when you accept that computer model as being accurate, i would suggest before you bring it out that you take the time to subject it to scientific scrutiny and now you're going to say we're going to treat millions of women based on a computer model and have not had a chance to critique and the reality plenty of data on real women there that shows it doesn't work. that shows it doesn't work. that's the issue. not like --

>> we do think.

>> it's not like the computer model is telling us something different than what the studies have shown. all the studies have shown it doesn't make a difference in younger women and it -- well --

>> i disagree.

>> in this country when we had a consensus conference in 1997 saying should we treat women under 50 the answer was no. and then how did we start treating women under 50 because the senate passed a nonbinding resolution told the nci that they should change their recommendations, not based on science , based on, you know, yelling and screaming by the radiologist and by other groups.

>> i agree. we should not be treating women by politics. you're absolutely right on that.

>> not doing it. we didn't start this based on science and, you know, it's about time we recognize that and we stopped doing it.

>> that's not true. science , the science suggested a long time ago, the start of age 40 is right.

>> no, no, that's not true. and we're one of the few countries that do this.

>> that doesn't mean the other countries are necessarily right, does it?

>> well --

>> they have the same results we do.

>> on that note, politics and breast cancer , politics in washington, d.c., and i want to thank both of you. dr. susan love and lin, thank you. a controversy that is going to stay with us for the next couple day as we hash out what these numbers really mean. my thanks to both of you.

>>> now, let's get a quick