Which women should get a mammogram for breast cancer screening?

What a great question!  This morning, Ted Ganiats, MD gave a great lecture on cancer screening at the KU Winter Symposium.  He compared the US cancer screening recommendations with their European counterpart reccomendations.

A few quick highlights:

• Europeans screen for colon cancer exclusively with FOBT and it has the same cost efficacy slope as colonoscopy
• 1 death is prevented from 13,000 mammograms in women over 50
• Women from 40-50 probably shouldn’t get a screening mammogram
• Europeans don’t even screen for prostate cancer because the evidence is lacking

The best evidence based guidelines have these qualities:

1. Level of evidence
2. Benefit
3. Harm
4. Cost
5. Value Judgments
6. Patient preference

Predicting a heart attack

Short of preforming a heart cath on every person, how do we assess risk of a heart attack?  For many years the best predictor has been a table generated from epidemological data from Framingham, Mass.

Last year the JUPITER trial suggested that asymptomatic, low risk persons undergo blood testing for high sensitivity C-reactive protein.

Now an Annals of Internal Medicine article from the US preventive task force rates nontraditional methods of screening for heart disease.

The results are both surprising and intuitive because the best predictive test turns out to be the one we use the most already: LDL.  They studied 9 tests: coronary artery calcium score as measured by electron-beam computed tomography, lipoprotein(a) level, homocysteine level, leukocyte count, fasting blood glucose, periodontal disease, ankle–brachial index, and carotid intima–media thickness.  There wasn’t enough evidence to make any of the tests significant in changing patient oriented outcomes.
I believe that LDL will continue to be the best predictor and that the new goals will try to push it as low as possible.  Does that mean that I should take a statin too? At age 28, male, and with an LDL of 83, I’m considering it.