I have just returned from the 21st Interdisciplinary Conference of the National Consortium of Breast Centers, which I want to become known as the Vegas Breast Conference. There was over 1000 attendees at this year's meeting. What makes it special is that it is not specialty-driven in its content or in those who attend. It truly is an interdisciplinary meeting comprised of physicians of all sorts (medical oncology, breast surgery, radiology, internal medicine, family medicine, obstetrics-gynecologgists, radiation oncologists), nurses, nurse practitioners, breast center navigators, radiologic technologists, survivors, and advocates. I can honestly say that I come back more motivated than ever to treat the women (and men, as I learned from after an eloquent and impassioned talk from survivor Brian Shappell this year during the Survivorship session) with breast cancer and to work in an Interdisciplinary environment.
On our Sunday plenary we indeed heard from the now former Chairman of the United States Preventive Services Task Force, Ned Calonge, and from our former Past-President of the NCoBC, Jay Parikh. They spoke on the controversy surrounding the 2009 guidelines on Screening Mammography published by the USPSTF, which we as a society have on record as being opposed to.
This presentation was so illuminating because Dr. Calonge showed all of us that the Task Force is indeed made up of human beings. He reminded us that the Task Force's mission is to review the evidence in support of screening methodologies in the cold light of evidence-based scientific methods and that it must be done in the absence of special interests, patients, and passions. But what was more striking was the revelation of the time course on the release of the recommendations. While its release occurred after President Obama took office and during the debate on health care reform, Dr. Calonge reminded us that his audience was intended to be primary care providers: internists, pediatricians, family physicians, and ob-gynecologists. He also reminded us that during the time of deliberation and release of the guidelines, the President was not Obama, but George Bush, and that there had been no talk of health care reform. There had been no expectation that the USPSTF recommendations would be tied to coverage and reimbursement decisions.
As equally informative was the discussion by Jay Parikh who raised the issues of the analysis undertaken by the Task Force. Flaws in methodology of the included randomized trials were brought to light, as were the countless studies performed in populations. While the latter were not randomized, the important question was: should they be completely ignored in the analysis. Dr Parikh went on to personalize the issue for those of us who work in breast centers and who have seen and discussed screening and seen women go through a diagnosis and treatment of breast cancer. Above all, Dr. Parikh made the point that none of us exist in a vacuum, that in medicine we treat patients and not numbers, and that passion should not be ignored.
While I doubt that many minds were changed in the audience (which is by definition made up of those who work in, participate in, and advocate for breast centers) I do believe the objective of the session was achieved: to understand the context of the recommendations, to provide a comprehensive look at ALL of the audience, so that in the end, each of us could make our own conclusions, which we could then take to our patients.
For more information, see Kate Madden Yee's excellent summary of this session at AuntMinnie.com