Addressing the Flawed USPSTF Breast Cancer Screening Recommendations

This post was submitted by Murray Rebner, MD, FACR, immediate past-president of the Society of Breast Imaging (SBI).

As a breast imager, former president of SBI, husband of a breast cancer survivor and father of a 28 year-old daughter, the past two weeks have been tough. On April 20 the U.S. Preventive Services Task Force (USPSTF), lacking scientific justification, was at it again recommending less frequent mammograms for American women, even though experts continue to maintain that regular screenings should commence at age 40. It’s déjà vu all over again.

My biggest concerns are the recommendations’ coverage implications. Under the ACA, health insurers are only required to provide coverage for health exams and procedures when a “B” grade is given by the USPSTF. The Task Force gave a “C” to annual screenings for women between the ages of 40 and 49 and a “B” to biennial screenings for women over 50. This grading has serious ramifications.

Say a woman is in her 40s and her physician decides that an annual mammogram is necessary. Under the Task Force recommendations, a woman’s health insurer can deny coverage for her exam. Because of this, she may choose or be forced to forgo the mammogram.

National Cancer Institute data has shown that breast cancer deaths in the United States have dropped by 35 percent since mammography became widespread in the mid-1980s. On top of this, published analyses have shown that if screening frequency is based on the USPSTF recommendations, thousands of additional breast cancer deaths will occur each year.

Frustrated yet? What will frustrate you even more is the lack of a compelling rationale for their recommendation. It is based in large part on highly criticized studies which describe the short-term anxiety women experience when radiologists see something suspicious on their mammogram that ultimately turns out not to be cancer. Research has found that almost all women whose mammograms are not normal want to know their status even if it doesn’t turn out to be cancer.

The bottom line is, the Task Force made a subjective value judgment rather than relying on scientific evidence. This could have been remedied had their process included the participation of breast cancer or cancer screening experts.

Luckily, this health threat doesn’t have to stand. Health and Human Services Secretary Burwell can and should affirm that coverage of annual mammograms should not be affected by the Task Force’s recommendations. Longer term, the bipartisan legislation (H.R. 1151) introduced by Representatives Marsha Blackburn (R-TN) and Bobby Rush (D-IL) should be enacted. It would bring greater transparency, plus stronger expert and patient input to the USPSTF process, helping to safeguard against situations like this.

In all of my above-mentioned roles, being a husband and a father are the most important, and from that lens the issue is clear to me – if a woman chooses to have a mammogram, she should be able to get it at the age and frequency of her choosing, and her insurance should cover it.

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