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Nov. 18, 2009

Something I thought was a bit bizarre was on the news this week from south of the border. The U.S. Preventive Services Task Force is recommending against women in their 40s having routine mammograms because false positives can lead to unnecessary biopsies, while not improving the overall odds of survival. It seemed to be a step backwards, but this apparently brings the American recommendations in line with what the Canadian Cancer Society has been saying for some time, which is that women in their 40s should speak to their doctors about individual breast cancer risk and whether they should be screened.

November 18, 2009 
By Peter Sells

I would suggest, then, that female firefighters should be especially proactive in this regard.  If they are under 50 and their doctors are not aware of the occupational cancer risks associated with firefighting, they may need to be assertive if they wish to receive mammograms as part of their health routine.

Likewise, male firefighters can choose to wait until age 50, in line with most recommendations, or they can get the Prostate-Specific Antigen (PSA) blood test at an earlier age. But, just like for early mammograms, the onus is on each individual to understand the risks and benefits. Two large international studies of 257,000 men published March 18, 2009, in the New England Journal of Medicine found that the benefits from a PSA test were fairly small and the risks in terms of unnecessary treatments were quite large.  One small-scale study – mine – says that one of my best friends is alive today only because he took the initiative to be tested early.

I am going to repeat one phrase from the first paragraph: “while not improving the overall odds of survival”. On the CNN segment that I saw, Dr. Sanjay Gupta described the current confusion over the new mammogram recommendations as an example of the difference between public health and individual health. What’s in the interest of all of us collectively may not be in the interest of each of us individually. From a document on the Region of Peel Public Health website: “If the goal is to increase the overall health status of a population (as it is for public health units), then health strategies that achieve a reduction (even a small one) in the risk factors for a vast number of people will have a much more telling effect than strategies that produce a great reduction of risk but for only a few specific individuals . . .  What is important is to find the right balance.”

The current public health topic is, of course, H1N1. Beginning this week I will be able to get my family vaccinated. From a public health perspective, the vaccines have been dished out for maximum overall benefit. From an individual perspective, it would have been most effective to have received the shot as early as possible.


So a blog question: How do the health interests of firefighters, collectively or individually, differ from or conflict with those of the general public?

Peter’s routine disclaimer: I am not a doctor, take everything I said with a grain of salt and call me in the morning.

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