Federal Panel Drafts Controversial Recommendations on Breast Cancer Screening

Debate surrounding the recommended age for women to initiate breast cancer screening has caused a stir between experts, and a draft proposal from the US Preventive Services Task Force (USPSTF) could potentially cause insurers to stop covering mammograms in younger individuals.

On Monday, the USPSTF issued a draft proposal saying that most women under 50 may not need regular mammograms to screen for breast cancer. Under the Patient Protection and Affordable Care Act, insurers can limit coverage for screening that the group does not support.

Currently, insurers are required to cover mammograms for women ages 40 and older every one to two years. Now, the panel has recommended to alter guidelines so that should get a mammogram every two years starting at 50 and beginning screening in women in their 40s should be a personal choice since the benefit of mammograms for this group is small. Additionally, the panel recommends screening for patients 50-74 every other year.

Since mammography screening became widespread in the mid-1980s, the breast cancer death rate in the US has dropped 35 percent, according to data from the National Cancer Institute (NCI).

The American College of Radiology (ACR) and the Society of Breast Imaging (SBI) did not agree with the panel’s draft proposal.

“We believe that the Secretary of the U.S. Department of Health and Human Services (HHS) can clarify now whether adoption of these USPSTF recommendations would mean that private insurers no longer have to cover mammograms for millions of women 40-49 who, together with their doctor, choose to have regular mammograms and those 50-74 who choose to be screened annually. We call on her to affirm that coverage will not be affected,” said Bibb Allen, MD, FACR, chair of the American College of Radiology Board of Chancellors.

According to the ACR, the USPSTF made a value judgement instead of a scientific one. In a 2014 study published in JAMA Internal Medicine, data shows that patients experience short-term anxiety regarding test results that rapidly declines over time with no measurable effect to women’s health from false positives. According to the USPSTF panel, false positives occur in 1,212 of every 10,000 women 40 to 49, and about one in five women diagnosed based on mammograms get treatment for cancer that otherwise would have gone undetected or never caused health problems.

But according to ACR, the new recommendations and its link with insurance coverage is effectively taking away individuals’ rights to choose whether they want to be screened for breast cancer, which is the second leading cause of cancer-related death in women.

“The USPSTF limited its consideration to studies that underestimate the lifesaving benefit of regular screening and greatly inflate overdiagnosis claims. They ignored more modern studies that have shown much greater benefit. These limitations result in the misrepresentation of the real trade-offs that women and health care providers need to know about in order to make good decisions about screening. They also ignored the demonstrated views of American women on screening. Unfortunately, these recommendations will only add to confusion that is placing women at risk,” said Barbara Monsees, MD, FACR, chair of the American College of Radiology Breast Imaging Commission.

The proposal is the same recommendation that the panel made in 2009. However, since the recommendation was so controversial, the Affordable Care Act required insurers to disregard it. ACR pointed out that no breast cancer experts serve on the panel and the USPSTF did not allow participation of experts at meetings where evidence was reviewed. ACR and SBI say that these recommendations should be regarded as “suspect” until experts are included in the creation of these guidelines.

“These USPSTF draft recommendations are based on a curiously selective analysis that does not foster a great deal of trust. Their recommendation creation process does not comply with IOM standards for trustworthy guideline creation that most major medical organizations are working to meet. This lack of transparency, lack of breast cancer expertise, and exclusion of studies that would support screening effectiveness and lower overdiagnosis estimates may result in unnecessary lives lost,” said Murray Rebner, MD, FSBI, president of the Society of Breast Imaging.

Source: American College of Radiology

Last updated: 4/21/15; 12:50pm EST

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