The guidelines generated controversy because of the emotional nature of mammography, Petitti says. "Many people know someone who has had breast cancer or had breast cancer diagnosed with mammogram and who believes or feels that the mammogram saved the life of that person," she says. The release of the recommendations also came out at a time when there was a lot of political debate about healthcare reform. "People that were opposed to the healthcare reform bill really seized on it, inappropriately in my opinion, as an example of the government not letting you do what you wanted it to do," she says. "It would have been controversial no matter what but definitely became fodder in the cannon in the battle for healthcare reform."
Still, Petitti says that mammography is just one example of how the healthcare industry can ensure that it doesn't fall into the trap of, This is how we did it before, so we should continue doing it that way forever. In general, there is a desire to be much more specific and tailor recommendations more directly to a person's individual risk, she says. "If we look at personalized medicine, in reality the mammogram guidelines were an attempt to make more personalized recommendations about when to have mammography. The one-size-fits-all approach is not a very good direction for not only preventive medicine but medicine in general."
Looking back over the past year, Petitti says there have been some positive outcomes from the controversy the recommendations generated. For example, there has been a call for a broader effort to systematize the approaches for recommendations based on evidence, she says. It also shined a light on the issue of groups that have a vested financial interest in a certain kind of recommendation. "A lot of positive things came out of this even though it definitely ruined my Thanksgiving," Petitti says. "Anytime you are changing something there is going to be a backlash, but it still needs to happen."