To mammogram or not

You may have heard about the new mammogram screening guidelines– from the American Cancer Society– that came out today (every year from 45-55; every two years thereafter).  This led to the best thing I’ve yet read on mamograms– a 538 post from Christie Aschwanden that puts this all in perspective.  Short version: it’s not about science, it’s about what sorts of trade-offs make sense in terms of false positives versus fatal cancers prevented.  Anyway, here’s the key chart:

aschwanden-feature-mammograms-nhs-2

I found this especially timely as my wife who is 43 recently had her first mammogram.  (I told her to follow the USPSTF guidelines and wait till 50, but hey, it’s her body).  She was called back for a second mammogram, which, of course, led to plenty of anxiety on her part.  Mammograms are more difficult and harder to get right on younger (under 50), denser breasts, so this was not at all surprising, but still a definite psychological cost.  As it turned out she’s actually got some old blocked milk ducts (how about that– it’s been around 4 years since they’ve been used), that looked funny, but she’s fine.  Of course, even if she had needed a biopsy, as you can see above, chances are strong it would have been unnecessary.

Anyway, here’s the key summary:

When weighing the benefits and risks, it’s helpful to look at absolute numbers. In a clinical review published in JAMA Internal Medicine on Tuesday, Karla Kerlikowske, a physician at the University of California, San Francisco, presented some figures: A woman’s lifetime risk of dying from breast cancer is 2.7 percent without screening. Kerlikowske calculates that a woman who follows the new USPSTF guidelines could drop that risk to 2.0 percent, and one who follows the ACS guidelines may reduce the risk a few decimal places more, to between 1.8 and 1.9 percent. To get these benefits, the USPSTF program requires 13 total mammograms in a woman’s lifetime, and the ACS regimen will result in 20 breast X-rays.

In exchange for these risk reductions, 61 percent of women who have annual mammograms and 42 percent of women who have biennial mammograms will be called back at least once for follow-up tests that reveal they do not have cancer, researchers write in an accompanying paper. The anxiety and stress of such a false alarm is the most common harm, but it’s not the only one.

In its own analysis, the USPSTF calculated that if 1,000 women follow its advice and have a mammogram every other year from age 50 to 74, 146 of them will be subjected to unnecessary breast biopsies and 18 of the 1,000 will be diagnosed and treated for a cancer that would have never harmed them (a problem called overdiagnosis and overtreatment). Women who have mammograms more often, as they would under the ACS guidelines, will experience more of these downsides.

And, about those trade-offs:

Underneath the debate about at which age and at what frequency we should urge women to get mammograms, another important question looms: Is it reasonable to recommend a test that will produce false positives for something like half of the people who take it? Is it OK to risk harming hundreds of women in hopes of helping a handful avert a breast cancer death? The ACS and USPSTF have concluded yes, but that’s a value judgment, not a scientific one.

Amid all this conflicting advice, patients have to make their own decisions. After more than 15 years reporting on this issue, I’ve decided to skip mammograms altogether. My No. 1 priority is to remain a healthy person and avoid unnecessary treatments, and opting out of mammographyreduces my risk of becoming a breast cancer patient by one-third. A smart friend of mine has examined the same evidence and come to the opposite conclusion, choosing to follow the ACS guidelines…

What we’re both seeking is assurance and certainty, and those are things that neither choice can guarantee.

Honestly, what I think is most useful is people actually understanding the choices that they are making.  And I think right now, far too few women actually do.

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What’s up with Rubio?

So, I still think Rubio may have the best chance of any Republican out there, but his latest fundraising sure was not impressive.  Then again, it may be a big thing that he’s now ahead of Jeb in the polls.  Politico had a pretty good story on Rubio’s situation:

The hype surrounding Marco Rubio’s presidential campaign just smashed into the wall of reality.

First, the Florida senator’s team insisted it had stashed more campaign cash in the bank than fellow Floridian Jeb Bush — only it hadn’t. The campaign also told reporters it had raised $6 million in the last fundraising quarter — also not true. That turned out to be an overly generous rounding of the underwhelming real figure: $5.7 million.

Yet those aren’t even the most troublesome parts of the Florida senator’s most recent campaign finance report. Rubio may be slowly rising in the polls, but his third quarter filing revealed a campaign that’s also out-manned by many of its rivals in the early-voting states. His staff is largely concentrated in Washington, with just a small umbrella of on-the-ground, early-state operatives — and he’s already at a disadvantage because he hasn’t invested the time in early-state visits that some of his opponents have.

For all the recent buzz surrounding his candidacy — fueled by strong debate performances — Rubio isn’t raising enough money to keep pace with his rivals in the top tier and he’s running out of time to assemble a robust field organization.

So, what’s going on here?  Of course SuperPac money can help, but despite all the thinking by people like me that Rubio’s campaign has got to catch fire at some time, we’re still waiting and his organizational deficits certainly do matter and don’t inspire confidence.

I still think Rubio is probably the man to beat.  But less than I did a few weeks ago.  Ezra is also feeling somewhat torn on the case for Rubio:

I keep telling people that I don’t believe Donald Trump will win the Republican nomination, but I also can’t tell a very convincing story at this point of what he does to lose it. But let’s say I’m right that he won’t win the nomination. What is there in this chart to suggest his support would flow to Rubio or Bush rather than to Carson, Cruz, or Fiorina?

Rubio is Trump’s stylistic opposite: young where Trump is old, Hispanic where Trump is white, courtly where Trump is brash, hopeful where Trump is angry, intellectual where Trump is instinctual, an insider where Trump is an outsider.

But Rubio is also Trump’s substantive opposite. Rubio is known for his work on immigration reform, his fiscal and social conservatism, and his closeness to the neocon wing of the Republican Party. Trump is known for his anti-immigrant rhetoric, his heterodoxies from fiscal and social conservatism, and when he gets specific on foreign policy, his instincts appear dovish.

The best argument that Trump’s support would run to Rubio is that Republicans will somehow get the message that Rubio is their best chance to win the White House, and they’ll vote accordingly. But if Republicans gave a damn about that message — or about the messengers who might deliver it — they wouldn’t be supporting Trump in the first place… [emphasis mine]

But Rubio’s support is roughly a third of Trump’s vote share — and it looks to have come largely at Jeb Bush’s expense. Imagine Rubio sees another surge, though. Rubio could take all of Bush’s voters and then add all of Rand Paul, Chris Christie, John Kasich, Lindsey Graham, Rick Santorum, Bobby Jindal, George Pataki, and Jim Gilmore’s voters, and he would still be trailing Trump.

According to the Huffington Post’s polling averages, Trump, Carson, Cruz, and Fiorina now command 61.3 percent of the Republican vote. To make the math work for Rubio, you somehow need an explanation for why he’s going to rip votes from the outsiders — the candidates who are everything he isn’t, and whom Republican voters seem to be favoring precisely because they don’t want an insider like Rubio.

The Democrat in me hopes that Republican primary voters are foolish enough to take their party off a general election cliff.  The political scientist in me still thinks it is unlikely, but a lot less unlikely than I was thinking not all that long ago.  One thing that has become pretty clear is that many Republican primary voters really do live in an alternate reality.  In this one, Rubio should be kicking butt in the polls.

Photo of the day

From an In Focus photos of the week gallery:

A swan is carried down the nave of the cathedral during the Procession of the Animals at the 31st annual Feast of Saint Francis and Blessing of the Animals at the Cathedral of St. John the Divine in Manhattan on October 4, 2015.

Elizabeth Shafiroff / Reuters

Old people are more everything

I’m not quite sure what this Pew comparison of generations actually tells us about different generations.  Here’s the chart:

Generation Gaps: Silents, Boomers See Themselves in a More Positive Light

To be sure, some of these differences may be related more to age and life stage than to the unique characteristics of today’s generations. Responsibilities tend to increase with age. As a result, it is possible that, in any era, older people would be more likely than younger people to view their generation as “responsible.” In addition, differences between old and young in such realms as patriotism, religiosity and political activism have been evident for many years. (See this explainer report for more on our approach to studying generations.)

On several measures – including hard work, responsibility, willingness to sacrifice, and self-reliance – the share in each generation expressing positive views declines step-wise across age cohorts, from the oldest to the youngest.

Actually, older people aren’t more everything.  They also seem to think they are less of everything bad:

Millennials Most Likely to Attribute Negative Traits to Their Generation

Oh come on, you just know older people are more rigid and less tolerant.  As for me, I’m feeling in the middle.  But I suppose that’s just because I’m Generation X.

Who supports Trump?

I haven’t done a Trump post in a while!  Anyway, I was long meaning to share this Richard Skinner post from last month looking at who supports Trump and was reminded to do so by this recent Ron Brownstein deep dive into the latest polling data.  Brownstein sums it up pretty succinctly:

The blue-col­lar wing of the Re­pub­lic­an primary elect­or­ate has con­sol­id­ated around one can­did­ate.

The party’s white-col­lar wing re­mains frag­men­ted.

That may be the most con­cise ex­plan­a­tion of the dy­nam­ic that has pro­pelled Don­ald Trump to a con­sist­ent and some­times com­mand­ing lead in the early stages of the GOP pres­id­en­tial nom­in­a­tion con­test.

Both na­tion­al and state polls show Trump open­ing a sub­stan­tial lead among Re­pub­lic­an voters without a col­lege edu­ca­tion al­most every­where. And in al­most all cases, Trump is win­ning more sup­port from non­col­lege Re­pub­lic­ans than any can­did­ate is at­tract­ing from Re­pub­lic­an voters with at least a four-year edu­ca­tion…

In oth­er words, Trump is ce­ment­ing a strong blue-col­lar base, while the white-col­lar voters re­l­at­ively more res­ist­ant to him have yet to uni­fy around any single al­tern­at­ive. That dis­par­ity is crit­ic­al be­cause in both the 2008 and 2012 GOP nom­in­a­tion fights, voters with and without a four-year col­lege de­gree each cast al­most ex­actly half of the total primary votes, ac­cord­ing to cu­mu­lat­ive ana­lyses of exit poll res­ults by ABC poll­ster Gary Langer. With the two wings evenly matched in size, Trump’s great­er suc­cess at con­sol­id­at­ing his “brack­et” ex­plains much of his ad­vant­age in the polls.

And, while I’m at it, here’s some still relevant insights from Skinner.  His post asks, “Do hate and racism drive support for Donald Trump?” and I think you know the answer (okay, “drive” might be a little strong, but you know it’s there):

Ethnocentrism. Authoritarians fear the “other.” No issue defines Trump’s campaign more than immigration—and, more so than any other candidate, he has been willing to use racially charged language in support of his positions. He also talks tough on trade and “law and order,” using polarizing language reminiscent of Patrick Buchanan or George Wallace. Trump seems to consistently appeal to ethnocentrism – favoring one’s own racial or ethnic group above others. Both in person and on-line, he attracts an alarming level of support from white supremacists. On the other hand, he vehemently backs “earned” entitlements like Social Security and Medicare, whose beneficiaries are disproportionately white. (This sets him apart from other Republicans like Jeb Bush and Chris Christie, who are more willing to back entitlement reform). Ethnocentric voters tend to display this combination of attitudes, judging policies based more on whether they apparently benefit their group rather than on more abstract criteria. European politics is now filled with extreme-right parties who back a welfare state—but only for our people…

Negative Partisanship: Alan Abramowitz and Stephen Webster have found that the past couple of decades have seen the rise of “negative partisanship.”  Voters are more likely to dislike strongly the opposite party. With racial, cultural, and ideological divisions now matching up with the partisan divide, Democrats and Republicans now see their opposites not just as mistaken, but as alien. Donald Trump’s credentials as a Republican, let alone as a conservative, are very weak. But his credentials as an anti-Democrat – and especially as an anti-Obaman—are much stronger. After all, he began his transformation from apolitical celebrity to right-wing hero, by engaging in the nastiest possible attacks on Obama: that he is a secret Muslim, that he was not actually born in the United States.  To some Republicans, if Donald Trump is saying bad things about That Kenyan in the White House, he can’t be all bad.

Trump has clearly had a drop in support from his peak, but he has nonetheless stabilized in the lead.  The good news for those who love watching politics (and for Democrats) is that Trump does not seem to be leaving us anytime soon.  (Also, I keep waiting for people to figure out that Carson is a clueless-about-non-brain-surgery-matters lunatic and for much of his outsider support to go to Trump, but who knows).

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