Last week, the federal government released new guidelines for mammograms, raising the recommended screening age from 40 to 50. And so far, the public's response has been overwhelmingly negative: Women hate them. Republicans hate them. And Republican women really hate them. So at the risk of alienating . . . oh, just about everybody . . . let me tell you why I think these guidelines are a good idea.

Get the new
PD toolbar!

Let me preface all of this by saying that like everyone I know, I have close friends and loved ones who've suffered from breast cancer and who benefited from early detection in their 40s. My heart goes out to them and I'm so glad that they are still with me.

But this isn't about that. This is about how a government can set a reasonable public health recommendation which -- by definition -- must assess risks and benefits across an entire population and figure out what makes the most sense.

As with so many things concerning health care, I'm also influenced by the fact that I'm an American living in the U.K., a country with guidelines nearly identical to those just proposed by the U.S. Preventative Services Task Force. When I first moved here, shortly after turning 40, and found out that mammograms weren't offered by the government (for free!) until age 50, I was apoplectic. "This is ridiculous!" I thought. "Just one more example of where socialized medicine really fails you!" But then I took the added step of trying to come up with research to suggest that starting at 40 or 50 was more valid. I couldn't. So I talked to some scholars who work in this area as well as several doctors. They all shrugged, and agreed that it's pretty murky, actually.

And it is. With that it mind, I'd like to suggest five reasons we ought to welcome these new guidelines on mammograms:

1. There are real health risks to early screening. In the brouhaha that erupted over the New York Times' front page story on this issue, everyone zeroed in on the argument that subjecting yourself to costly and potentially unnecessary mammograms in your 40s can induce undue anxiety. To paraphrase my colleague Ria Misra's response, "I'll take the anxiety." But the harms aren't just in the realm of mental health (which shouldn't be dismissed, as Andrea Stone's compelling first-person account of her own false-positive attests.) The radiation from regular mammography also poses serious health risks. One expert cited studies showing that such radiation causes one death for every 2,000 women screened annually starting at age 40, and that each mammogram increases the risk of breast cancer by 2 percent. He also said that self-examination has been shown to have no effect on preventing deaths; it only increases the number of biopsies.

2. Having more information is always better. Even in countries (like the U.K.) where screening occurs later on and less frequently, women are appallingly ill-informed about the downsides of over-screening. One survey of 479 women in countries with government-sponsored screenings showed that only 7 percent were aware that some cancers grow so slowly that even without treatment, they won't affect a woman's health. In the U.K., a group of health professionals wrote a letter to the Times of London criticizing the government for its "unethical failure" to provide women with the full facts (including a recent study in the British Medical Journal showing that for every one woman whose life is saved by mammograms, 10 undergo unnecessary diagnostic procedures and treatment). None of this is to say that you shouldn't look carefully at your own risk factors and family history and then decide, with your doctor, when to begin mammograms. But I think we can all agree that a fully informed citizen makes better choices.

3. This is a recommendation, not an order. As the Obama administration has been at great pains to remind us -- these guidelines are not legally binding. They are just advice, telling us what a group of highly esteemed (Bush appointed!) experts recommends, based on the best available scientific evidence. Mammograms are currently mandated in 49 of the 50 states and there are no plans to stop mammograms under Medicare. And so far, at least, insurance companies don't seem inclined to stop their coverage of annual mammograms from age 40 either. Yes, down the line, all of that might change as we (inevitably) continue to hash this out. And perhaps it should. For the moment, however, the entire purpose of these guidelines is to encourage policymakers to include additional considerations and "individualize decision making to the specific patient or situation." Who can argue with that?

4. The guidelines conform to international standards. As I noted earlier, both Canada and the U.K. already have mammogram guidelines in place that are quite similar to those that the task force recommends. Some will invariably counter that according to a recent cross-national study of world cancer survival, the U.S. outperformed the U.K by a considerable margin, including where breast cancer was concerned. But the U.S. was virtually tied with Canada. And I'd urge you to read this detailed analysis of that study by a health economist to determine what we can reasonably infer from it.

5. Health care rationing is inevitable (and already here). Because of the toxicity of the word "rationing" in our current political climate, everyone's swearing that these new guidelines don't amount to rationing. They don't. Not now. But if they ever filter into policy or insurance premiums, they will of course amount to rationing (if by rationing we mean putting limited governmental resources toward health interventions that have the most impact). And they should. As I thought we all realized by now, there's absolutely no way to reform our public health care system without ruling out costly tests that don't have proven health benefits. (Or did I miss something along the way over the past six months?)

Mammograms are expensive -- 37 million of them are done annually, each of which costs about $100. And one of the reasons they are not being recommended for all women in their 40s is that the cancer risk is small in this period, and breast tissue remains much denser at that age, reducing the accuracy and benefits of X-rays to begin with. So using science to determine exactly which interventions ought to be prioritized on the public's dime is precisely what all sensible national health care systems do. (All of which -- it bears repeating -- consistently outperform our own.) More pointedly, as David Leonhardt pointed out in a particularly trenchant analysis over the summer, our health care system already rations treatment in all sorts of ways. We just don't call it that.

Finally, it's worth pointing out that what's gotten lost in all of the uproar over the past week is that the task force's recommendations will ultimately be used to provide women access to effective preventive services for breast cancer for free or at low cost. The advisory panel is just trying to help doctors, insurance companies -- and, yes, you and me -- figure out when it makes the most sense to do this. Now that's change I can believe in.

Follow Delia on Twitter.




Follow PoliticsDaily On Facebook and Twitter,
and download the new Politics Daily toolbar!