Jump to comment:
- It may be good to ignore guidelines
Editor,
You do your readership and their patients a disservice by implying that physicians who do not adhere to the Canadian Task Force’s guidelines have distorted perceptions of the value of medical tests. Dr. Lang, an emergency physician, and his colleagues on the Task Force are not experts in the fields for which they issue guidelines. They consult experts, but then are free to ignore their input. This was certainly the case with their recent “update” on guideline for breast cancer screening of women at average risk. Though they stated that they had reviewed the most up-to-date data, they did quite the opposite: They considered only randomized controlled trials (RCT) of mammography screening done from the 1960s to the early 1990s, using equipment that is now obsolete. They did not include the 2014 Pan-Canadian observational study of 2.7 million women showing a 40-44% mortality reduction among screened women.
Randomized trial design works well for drug trials. In a technology-dependent study, by the time the study has matured to the point that mortality reduction can be measured, the technology has advanced, and that used in the trial is no longer in use. The RCTs of mammography used x-ray film mammography. This has been replaced with digital mammography, which is more sensitive at cancer detection.
Furthermore, RCTs only demonstrate mortality reduction. Early detection of breast cancer allows 3 other important benefits NOT considered by the Task For...
Show MoreCompeting Interests: None declared.