Prevention Matters

The Senate voted 61-39 Thursday "to safeguard coverage of mammograms and preventive screening tests for women under any health care overhaul legislation." The revision, which was advanced by Sen. Barbara Mikulski, D-Md., Sen. Olympia Snowe, R-Maine, "would allow the Health and Human Services secretary to require insurers to cover preventive health screenings free of charge."

The vote came in the wake of recent controversy over federal task force recommendations that women in their 40s consult with their doctors about the advisability of getting mammograms, rather than considering them a routine procedure. On a 59-41 vote, the Senate rejected an amendment by Sen. Lisa Murkowski, R-Alaska, to ensure the task force recommendations could be ignored.

Partnership for Prevention and 10 of the nation's leading health and prevention organizations have sent a letter to Congress defending the recent recommendations of the US Preventive Services Task Force regarding breast cancer screening and set the record straight about recent public misstatements regarding the recommendations.

“The U.S. Preventive Services Task Force was established as an independent body to apply rigor and objectivity to the analysis of clinical preventive care – even on issues that arouse passions and political posturing,” the organization leaders said in a letter to Rep. Henry Waxman, D-Calif.., and Rep. Joe Barton, R-Texas. “The misstatements we have noted are evidence of both of these dangers, and the Task Force is our best defense against both.

“Our common goal is for preventive services to improve the health of all Americans,” they continued. “We believe the Task Force is the best way to ensure we’re guided toward that goal by recommendations of experts who are guided by science, and only by science.”

The letter was signed by leaders of the following organizations: American Academy of Family Physicians, American Academy of Nurse Practitioners, American Academy of Physician Assistants, American College of Physicians, American College of Preventive Medicine, American Journal of Preventive Medicine, American Public Health Association, National Association of County and City Health Officials, Partnership for Prevention, Public Health Institute, and Trust for America’s Health.

Waxman and Barton are the chairman and ranking Republican of a House committee that held a Dec. 2 hearing on the USPSTF recommendations.

The letter, a copy of which is available online at http://www.prevent.org/images/mammographyletter.pdf
specifically addressed three misstatements:

• The Task Force recommends that women aged 40 – 49 not receive mammograms. “The Task Force does not recommend that all women in this age group automatically start receiving mammograms at age 40.” the letter states. “Rather, it simply recommends that those women and their health care professionals have a full discussion about the potential pros and cons of screening. This allows the patient to incorporate information about her family history, overall health, and personal values and preferences along with the best scientific information into the decision-making process.

“The result is an empowered patient who is able to make an informed decision about whether or not to be tested. In fact, many women may choose to continue mammography because they value the small chance that they might benefit, but other women may choose to defer beginning mammograms until the balance of benefits and risks is more favorable.”

• The Task Force recommendations were intended to reduce costs. “The Task Force never uses cost as a reason to recommend against a service that has been proven to be effective,” the letter states. “In its review of the evidence about breast cancer screening, the Task Force had a single objective – to determine how to maximize the health of women.”

• Members of the Task Force are not qualified to make scientific recommendations. “Since its inception (in 1984), it has been recognized as the authoritative source for determining the effectiveness of clinical preventive services, and its methods have been adapted by guidelines groups worldwide,” the letter says. “While this small group of distinguished health care professionals and researchers is largely unknown to the general public, its work is well known to clinicians in preventive and primary care practice...The preventive services recommended by the Task Force have prevented hundreds of thousands, if not millions, of premature deaths and averted needless harms.

A couple of women's health experts have turned the tables on some of the critics who accuse the US Preventive Services Task Force of potential conflicts of interest regarding its mammogram recommendations.

Dr. Adriane Fugh-Berman MD of Georgetown University Medical Center, and director of PharmedOut.org and Alicia M. Bell, project manager of PharmedOut and member of the board of directors of the National Women's Health Network, identified specific potential conflicts of interest in some of the critics. Their article in the Hastings Center's Bioethics Forum, entitled "Mammography and the Corporate Breast," is an interesting read.

"The fact is that guidelines for screenings do change (quite frequently) over time based on continuing research. To have some means to continue such deliberation is to recognize the value of evidence-based medicine."

- The New Republic's Suzy Khimm, in an article entitled "Who Will Decide If Women Have to Pay for Mammograms?"

A congressional subcommittee chairman said he called a hearing this week "to get to the bottom" of a recent task force recommendation on mammogram screening for women in their 40s.

"My goal is to get to the bottom of why the task force made these recommendations," Rep. Frank Pallone, D-Va., told the New Jersey Star-Ledger. "Has anything changed in the way we’re looking at testing? And find out about better ways of breast cancer screening to develop in the future, including more efficient blood tests and exams with no radiation impact."

Pallone, who chairs the health subcommittee of the House Energy and Commerce Committee, says the recommendation made it "very confusing for women deciding what to do."  He said he wants insurance companies to continue to allow coverage for those women who want the mammogram at a younger age, and said the flap should not affect the outcome of health reform legislation.

"There’ll always be disagreements about tests and procedures," he said. "Health care reform needs to move forward, as fast as possible. More people lack coverage, insurance premiums and drug prices are going up. We can’t delay it any longer."

A USA TODAY/Gallup Poll of American women indicates that most of them plan to disregard the new recommendations from the U.S. Preventive Services Task Force about mammograms. The poll also shows that most women sharply overestimate their risk of developing the disease.

The task force last week suggested that most women don't need mammograms on a routine basis until age 50. Women under 50 should consult their doctors to see if mammograms are approrpriate for them.

In the survey of 1,136 women, 76% said they disagree or strongly disagree with the recommendations, while 84% of women ages 35 to 49 said they plan to get mammograms before age 50 despite the task force recommendations.

But the poll found that most women have misconceptions about the disease and the panels' motives. Seventy-six percent the panel based its conclusions on cost, even though the task force's report included only scientific studies. Forty percent estimated that a 40-year-old's chance of developing breast cancer over the next decade is 20% to 50%. But the real risk is 1.4%, according to the National Cancer Institute.

Partnership for Prevention President/CEO Robert J. Gould, Ph.D. today issued the following statement about the revised recommendations of the US Preventive Services Task Force regarding breast cancer screening:


The US Preventive Services Task Force is the nation’s best-equipped institution to make science-based recommendations on the use of clinical preventive services. Accordingly, we accept their recommendations on breast cancer screening.


To help avoid any possible confusion about these new recommendations, we would strongly note three areas where theyhave not changed:

• Mammograms are still recommended for women 40-49 with high risk of breast cancer;

• Mammography has clearly been shown to save lives and is a vital component of our nation’s arsenal to fight breast cancer; and

• All women should talk with their physicians about their individual risks and the value of screening.