The U.S. Preventive Services Task Force (USPSTF) published new mammography guidelines in the November 17 issue of Annals of Internal Medicine. As published, “The USPSTF recommends against routine screening mammography in women aged 40 to 49 years. The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take into account patient context, including the patient’s values regarding specific benefits and harms”.
Not unexpectedly, the publication has resulted in an outpouring of reactions from both the public and the medical community. Many healthcare providers, medical societies and institutions do not recommend waiting until 50 for mammography screening, citing flaws in the analysis and methods used to develop the new guidelines. Most agree there are limitations to mammography, but imaging technologies are improving and are currently better than those used in the studies reviewed by the USPSTF. Since radiologists, the only specialists trained in mammography, were not represented on the Task Force, the expertise of the panel has been called into question. Additional concerns have been expressed regarding the modeling data utilized and pivotal clinical data that was not considered by the USPSTF.
The American College of Radiology has voiced strong opposition to the guidelines stating two decades of decline in breast cancer mortality could be reversed if women 40-49 are not screened. “These unfounded USPSTF recommendations ignore the valid scientific data and place a great many women at risk of dying unnecessarily from a disease that we have made significant headway against over the past 20 years. Mammography is not a perfect test, but it has unquestionably been shown to save lives ─ including in women aged 40-49” said Carol H. Lee, M.D., chair of the American College of Radiology Breast Imaging Commission.
| The American Cancer Society continues to recommend annual screening using mammography and clinical breast exams for all women beginning at age 40. |
USPSTF Defends Mammography Guidelines
The U.S. Preventive Services Task Force responded to the reactions to their mammography recommendations on December 2, 2009 before a congressional panel. During the panel, the USPSTF states they did not tell women under 50 not to have mammograms, but that screening women under 50 is supported by limited clinical evidence and that women should decide with their physicians.
Regardless of whether physicians and patients adhere to the Task Force recommendations, the revised guidelines may have many unintended consequences for women. Although the USPSTF is an independent panel, the Medicare Improvements for Patients and Providers Act of 2008 gave HHS the authority to consider USPSTF recommendations in Medicare coverage determinations for preventive services. Additionally, private insurers may incorporate the AHRQ-funded USPSTF recommendations as a cost-saving measure. Thus, there exists considerable potential for the guidelines to impact reimbursement for many women down the line.
A United Voice for Mammography
Get Primed! and Menopause Alliance are committed to supporting mammography screening for all women 40+. We need a strong, united voice to represent our needs to decision and policy makers. So please, join us and add your voice to the conversation.
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