This entry was written by Janine E. Guglielmino, LBBC Director of Publications and Strategic Initiatives
Our members have been burning up the phone and DSL lines since news hit on November 19 that the U.S. Preventive Services Task Force (USPSTF) changed its breast screening recommendations. Among the controversies: the task force’s finding that women aged 40 to 49 who are at average risk for developing breast cancer do not benefit as much from annual mammography as women aged 50-70.
If, like me, you’re following this debate closely, you might be having trouble keeping up with the players—and their changing points of view. Four days after the task force released its recommendations, U.S. Secretary of Health and Human Services Kathleen Sebelius said in a statement, “Mammograms have always been an important life-saving tool in the fight against breast cancer and they still are today.” Since HHS oversees the work of the task force, it’s reasonable to ask, “Well, which is it? Mammogram or no mammogram?”
Nearly every major player in the breast cancer community has taken a stance. Among them:
LBBC opposes the new recommendations, but not for the reasons you might expect. We believe the members of the task force are professionals, and politicians and insurers did not influence their findings (but we’re not naïve; we realize some insurers may use the recommendations to change coverage). Simply put, LBBC has different priorities, and a different emphasis, than the task force. We also feel clearer communication could have helped us and our members better understand the task force’s perspective. If you read the recommendations closely, they do not say “If you are between 40 and 49, you don’t need annual screening mammograms because they will not help you.” Instead, they explain that the benefits of mammography increase and the risks decrease as we age. There are several reasons why; most notably, after age 50 a woman is more likely to have breast cancer, so the “risks” of false positives, negative biopsies and test-related anxiety decrease because the mammogram is more likely to save a life. Most of the studies the task force reviewed show that mammograms save the lives of women in their 40s. They just don’t save as many. And from the point of view of a public health professional, that means the “risks” (exposure to radiation, etc.) could outweigh the “benefits”—not for any particular individual (like you or me) but for society as a whole.
That message is perhaps the hardest to swallow, but it’s the task force’s job to look for societal benefit. The USPSTF is a 16-member panel of primary care providers (doctors and nurses) with expertise in the field of public health, which studies (among other things) the prevention of disease in large groups of people. It “conducts rigorous, impartial assessments of the scientific evidence for the effectiveness” of preventive services like mammography and issues recommendations that, while influential in setting professional standards, do not force insurance companies, physicians or the government to use them. All recommendations are for “asymptomatic populations”—not for people who have breast lumps—which explains why cancer doctors do not serve on the task force.
LBBC opposes USPSTF’s new recommendations because we are interested in both individual and societal benefits. We believe women in their 40s are thoughtful enough to weigh the risks and benefits of annual mammography and make a reasonable decision for themselves; we also feel women are emotionally strong enough to cope with the fears and anxieties of false-positive results. Although we understand the importance of considering financial costs, we value individual lives above the price of a mammogram. Yes, it’s true: Mammograms are not perfect, especially for those of us who haven’t gone through menopause. But it makes no sense to us to throw the baby out with the bathwater. Until we find a better test, mammograms remain our best, and most economical, tool to detect breast cancer in a woman in her 40s.
What are your thoughts on LBBC’s statement and/or the USPSTF’s guidelines? We want to hear your thoughts! Either leave us a comment below or continue the conversation on Facebook.