New Mammogram Guidelines Unleash Firestorm of Criticism

At a time when Americans are concerned about government involvement in health care, a HHS-appointed panel released a controversial statement.

WASHINGTON, D.C. (Catholic Online) - In a major health care reversal, the U.S. Preventive Services Task Force (USPSTF), a panel of doctors and scientists appointed by the Department of Health and Human Services, declared that women don't need mammograms until age 50 and that self-examination doesn't make any difference in breast cancer discovery.

The findings, released on Monday, have unleashed a firestorm of comments from physicians and breast cancer survivors who are only alive because of early discovery.

The Task Force stated that the previous recommendation of mammograms at age 40 can lead to false alarms and unnecessary biopsies. "The benefits are less and the harms are greater when screening starts in the 40s," accord to Vice Chairperson, Dr. Diana Petitti.

"For women 40 to 49, the task force found it was a very close call in that age group," stated Dr. David Grossman, another member of the panel. "The benefits are relatively small in that age group, and women should be aware of the potential harms that are associated with it. By routinely recommending mammography, we are subjecting women to a regular risk of harm that is more so than for older age groups."

The panel also indicated that mammograms should only be done every other year, that breast examinations by doctors are of little value and that self-examination is useless.

Critics of the panel's findings have taken issue with the statistical approach in coming to their conclusions. Otis W. Brawley, M.D., Chief Medical Officer for the American Cancer Society, stated, "With its new recommendations, the USPSTF is essentially telling women that mammography at age 40 to 49 saves lives; just not enough of them.

"The task force says screening women in their 40s would reduce their risk of death from breast cancer by 15 percent, just as it does for women in their 50s. But because women in their 40s are at lower risk of the disease than women 50 and above, the USPSTF says the actual number of lives saved is not enough to recommend widespread screening."

Brawley also said, "The American Cancer Society continues to recommend annual screening using mammography and clinical breast examination for all women beginning at age 40.

"Our experts make this recommendation having reviewed virtually all the same data reviewed by the USPSTF, but also additional data that the USPSTF did not consider. When recommendations are based on judgments about the balance of risks and benefits, reasonable experts can look at the same data and reach different conclusions."

The American College of Radiology (ACR) issued a statement saying that the USPSTF mammography recommendations will result in countless unnecessary breast cancer deaths each year.

Dr. Carol H. Lee, Chair of the ACR's Breast Imaging Commission issued the stated, "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. These new recommendations seem to reflect a conscious decision to ration care.

"If Medicare and private insurers adopt these incredibly flawed USPSTF recommendations as a rationale for refusing women coverage of these life-saving exams, it could have deadly effects for American women."

James H. Thrall, M.D., FACR, chair of the ACR Board of Chancellors, added, "I am deeply concerned about the actions of the USPSTF in severely limiting screening for breast cancer.

"These recommendations, in combination with recent CMS imaging cuts, jeopardize access to both long proven and cutting-edge diagnostic imaging technologies. Government policy makers need to consider the consequences of such decisions.

"I can't help but think that we are moving toward a new health care rationing policy that will turn back the clock on medicine for decades and needlessly reverse advances in cancer detection that have saved countless lives."

A more detailed report from the American College of Radiology can be found at http://www.acr.org/HomePageCategories/News/ACRNewsCenter/UPSTFDetails.aspx.

Dr. Kristen Zarfos, director of the Comprehensive Breast Health Center at St. Francis Hospital and Medical Center in Hartford, CT told the Hartford Courant that the recommendations made by the U.S. Preventive Services Task Force were a step back for health care. She stated current practices have helped lower the breast cancer-related death toll 3.3 percent each year for women aged 40 to 50 over the past 12 years.

"To withhold a tool that finds breast cancer in its earliest stage in women with the highest risk," she told the Courant, "one has to wonder what their goal is."

Dr. Nagi Khouri, director of breast imaging at Johns Hopkins University Hospital, told the Baltimore Sun that last year nearly 27 percent of the 620 cancers they diagnosed were found in women in their 40s.

While some cancers are harmless, Khouri indicated that others are deadly and there's no way for doctors to detect the difference.

"There is no doubt that some are unlikely to kill a person," he said. "But the majority will progress into invasive cancers, grow larger, spreading and killing a person."

"We may be at the beginning of a bad trend," Khouri added.

Not all health care organizations and professionals are critical of the panel's new guidelines. According to the National Breast Cancer Coalition, "The over-emphasis on the importance of screening, despite a lack of strong evidence, has been elevated to such a degree that some even equate screening with prevention of breast cancer.

"The National Breast Cancer Coalition (NBCC) hopes that today's release of the US Preventive Services Task Force (USPSTF) revised recommendations will put the brakes on this run-away train and will put screening and its limitations into proper perspective...

"For over ten years, the National Breast Cancer Coalition has reviewed and analyzed each newly published article looking at the trials of mammography screening. After each analysis, NBCC has continued to take the position that mammography screening has significant limitations and should be a personal choice rather than a public health message."

"The issues are not simple," the NBCC stated, "but we believe women can comprehend the complexities of breast cancer and screening for the disease. Women deserve to know the facts and have the right to make informed decisions regarding their health care.

Dr. Amy Abernethy of the Duke Comprehensive Cancer Center told the Associated Press that she agreed with the task force's changes.

"Overall, I think it really took courage for them to do this. It does ask us as doctors to change what we do and how we communicate with patients. That's no small undertaking."

In a conversation with the Baltimore Sun, Dr. Richard Colgan, who is a family physician and an associate professor at the University of Maryland School of Medicine, stated that while the task force is respected as the "gold standard" of advisory panels, primary care doctors are flooded with recommendations on hundreds of different diseases. He said sometimes doctors follow the guidelines and sometimes they don't.

He indicated that he will use the new guidelines to discuss the matter with his patients even though he used to recommend mammograms to his patients beginning at age 40. He said he hopes other doctors will do the same.

"Maybe I'm idealistic," he told the Sun, "but not only can they have this conversation with their doctors, they should."

On her blog, "The Skeptical OB," Dr. Amy Tuteur, an OB/GYN who is a former clinical instructor at Harvard Medical School, reported that the findings of the USPSTF are somewhat similar to a report from the National Institutes of Health recommendation from January, 1997.

The report stated, "The National Institutes of Health (NIH) Consensus Development Conference on Breast Cancer Screening for Women Aged 40-49 ... concluded that data on the benefits and risks of screening mammography for women aged 40 through 49 are sufficiently mixed that informed decision making, rather than a blanket recommendation for all women, is an appropriate course of action."

Breast Cancer survivors are, by far, the strongest and most strident voices of criticism regarding the new guidelines from the USPSTF. Weighing in through quotes in news articles, comment sections in online newspapers and blogs, story after story of how both mammograms and self-examinations have saved lives are being told.

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Randy Sly is the Associate Editor of Catholic Online. He is a former Archbishop of the Charismatic Episcopal Church who laid aside that ministry to enter into the full communion of the Catholic Church.

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