The bad news is in and the Ontario Liberals have revealed that the budget deficit is a billion dollars higher than they led us to believe during the  election. Scandalous stuff, but both the other parties were keeping the same secret, and this is a subject for a different post.

In keeping with the spirit of government austerity plaguing the Western world and prolonging the recession, the Ontario Liberals will be looking to cut where they can. Which brings us to health care. New Canadian guidelines for mamograms and breast cancer screening have been released, sparking an uproar.

Health care costs in Ontario continue to rise at about 8% anually, and this is not sustainable.

The problem is that a lot of time and effort has been invested to raise public awareness of breast cancer issues, and most people consider mamograms and breast cancer screening to be good ideas. We know what those pink baseball bats represent.

The Canadian Task Force on Preventive Health Care estimates that 2,100 women in their 40′s would have to be screened every 2-3 years for 11 years to prevent one breast cancer death. At the same time, 690 of those 2,100 would have a false positive result, with about 75 having to undergo unnecessary needle biopsies. Unwarranted lumpectomies and even removal of breasts could occur.

Why would this happen? Early screening and detection is a good thing, right? As with many things, it turns out that the devil is in the details. Malcolm Gladwell outlined the issue in an article he wrote for the New Yorker. We tend to think of mamogram results as a definitive science — you have breast cancer or you don’t. It turns out that for radiologists, reading mamograms is a least as much art as it is science. There are so many gray areas of interpertation that it often comes down to the personality of the radiologist. Some radiologists see something ambiguous and are comfortable calling it normal. Others see something ambiguous and get suspicious.

To further complicate the issue, it seems that some kinds of breast cancer may naturally spontaneously appear and disappear. Witness this study of autopsies of women, in which 20% of women autopsied were found to have breast cancer. Since we know that 20% of women don’t die of breast cancer, researchers are starting to suspect this might be a  natural phenomenon.

Logic would seem to indicate that the Canadian Task Force on Preventive Health Care is on solid ground.  But you wouldn’t feel that way if your life of the life of someone you know was saved by a mamogram.

Health care spending can’t continue to grow at 8% annually. We have to find some efficiencies.  Is this one reasonable?