You are quite correct, it is entirely a matter between the patient and the doctor. The panel in question merely provided recommendations which are in no way binding upon anyone. Patients should make those informed decision on their own and the recommendations of this panel do not change that.

I think that when you thinking about the “costs” of mammograms you are thinking about the actual price of the procedure. However what the panel did was look at other “costs”, specifically increased risk to the patient. A mammogram exposes breast tissue to radiation (X-rays) which increases the risk of cancer, albeit a very small risk. So each mammogram is a balancing act, balancing the risk of exposure to x-rays vs. the risk of not detecting breast cancer early enough to effectively intervene. Additionally, a mammogram may detect a “lump” that is not a cancer (a “false positive”) which will result in biopsy. Biopsies are not risk free either and pose their own problems. For example it is not unheard of for infections to result from biopsies, to say nothing of internal bleeding and other complications. A biopsy is also a balancing act, balancing the risk from the biopsy itself vs. the risk of not identifying a cancer. It is these “costs” that are being considered.

On the other hand, if, as the panel believes, there are no benefits for women aged 40-49 from mammograms, then the above mentioned “costs”, risks from the testing procedures, are greater than the benefits. This is all very cold and clinical and contrary to previous practice, but that is the math and that is how health policy needs to be determined.

I first want to not that this sort of determination is actually an entire field of study. One can go to grad school (usually in a School of Public Health) and get one’s degree studying when things like testing or immunization are effective and when they are not. The question of balancing the benefits of testing for example (prevented diseases and deaths) against costs of false positives and false negatives. In case of false positives with breast cancer, unnecessary biopsies and unnecessary radiation exposure. In the case of false negatives, expensive tests are performed with no accompanying life extending benefits. You can actually punch all of this into an equation and literally do the math on whether testing is warranted or not.

I think part of the problem is that when the question of “cost – benefit analysis” is discussed, there is a tendency to see the “costs” as simply the price of the test. Of course that is a consideration but the cost here is of unnecessary biopsies which can have serious health implications. If false positives from mammograms result in unneeded biopsies, which compromise the patients long term health, and the mammograms themselves produce no additional benefit to women 40 – 49, then the math is pretty simple.

AAA, 1% of all breast cancer deaths (440 per year in the US) are men.