Failure to Communicate: Setting the Record Straight on Mammographies

Janice Simmons, for HealthLeaders Media , December 3, 2009

To refocus the argument and address the concerns, representatives of the task force found themselves in front of the House Energy and Commerce Health Subcommittee to say their earlier recommendations were "poorly worded"—leading the public to think they were suggesting screenings were unneeded for patients in their 40s.

To clarify, Diana Petitti, MD, MPH, the USPSTF vice chair, acknowledged that the initial communication was not very good. "The task force acknowledges that the language used to describe its 'C grade' recommendations about breast cancer screening for women 40 to 49 did not say what the task force meant to say. The task force communication was poor."

She also noted the harms and benefits that the panel weighed in making its evaluations—which sometimes might not seem that clear-cut. While benefits "are easy to communicate," the harms are somewhat harder to understand—such as false positives.

"No matter how the concept of screening is explained, a positive mammogram means cancer until cancer is proven not to exist. For some women who have a positive test, the time between a positive test and an answer is mercifully short. For other women, follow-up includes additional tests . . . and anxiety and psychological distress."

It's with these findings, she said, that "mammography starting at 40 should not be automatic." Instead, the task force recommends that "women in their 40s [should] decide on an age to begin screening that is based on conversation with their doctor as an individual."

Now that’s something to communicate to everybody.

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Janice Simmons is a senior editor and Washington, DC, correspondent for HealthLeaders Media Online. She can be reached at

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