Task Force Clarifies Breast Cancer Screening Recommendations; Editorials, Opinion Pieces Respond To Guidelines

Main Category: Breast Cancer
Article Date: 24 Nov 2009 - 5:00 PST

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On Thursday, members of the U.S. Preventive Services Task Force clarified their new breast cancer screening guidelines after receiving "intense backlash" from some experts and breast cancer survivors, the Wall Street Journal reports. The new USPSTF guidelines recommend against routine screening mammography in women ages 40 through 49, recommend biennial screening mammography for women ages 50 through 74 and recommend against clinicians teaching women how to perform breast self-examinations.

Task force members said that they did not intend to convey that women in their 40s should not get mammograms or that women should be discouraged from examining their breast for lumps. Task force co-chair Diana Petitti, a professor of biomedical informatics at Arizona State University, said that the panel believes that women in their 40s should decide on their own, after consulting their doctors, whether to begin mammograms (Wang et al., Wall Street Journal, 11/20).

Several newspapers published editorials and opinion pieces responding to the guidelines. Summaries of selected opinions appear below.

Editorials

~ New York Times: Opponents of health care reform legislation "have seized on the new recommendations as evidence that the government is seeking to put bureaucrats between you and your doctor or that it would ration care by denying coverage for some mammograms that are now covered," the editorial says. However, there is "virtually no chance that any insures, either private or public, will deny coverage to anyone based on these recommendations," and the "only part of the reform bill that could affect mammography would only make them more accessible," it continues. "There is nothing wrong with a healthy public debate about mammography within the medical community and among women who must decide when and how often to get screened," the editorial says, concluding, "It should not be injected in the partisan debate over health care reform" (New York Times, 11/20).

~ Los Angeles Times: The recommendations "shouldn't be discarded outright by a medical establishment that has grown accustomed to viewing mammograms as a major lifesaver," a Times editorial says. It adds, "Contrary to earlier thinking about cancer -- that all of it spreads and kills if untreated -- some cancers never present a real health risk, and mammograms are less effective at finding the more aggressive ones." The editorial continues, "We agree with experts who say better screening methods are needed, but until those come along, these recommendations have confused medical decision-making rather than guided it" (Los Angeles Times, 11/20).

~ San Francisco Chronicle: "Women are right to be surprised and confused" by the new guidelines because they "have been bombarded with messages about annual screenings" for years, a Chronicle editorial says. However, doctors and researchers "are just beginning to understand the dangers of too much screening," such as false positives, unneeded surgery and radiation exposure, it adds. "Breast cancer screening is notoriously imperfect," the editorial states, adding, "Above all, what this controversy has shown is that scientists need to device a more accurate test for breast cancer" (San Francisco Chronicle, 11/20).

~ Philadelphia Inquirer: The "deep divide in the medical community" over the new guidelines "underscores the need for improved technology and more research about breast cancer" prevention, detection and treatment, an Inquirer editorial says. "Unfortunately, with the new guidelines, there are no clear-cut answers for women to figure out when to undergo screening and how often," it continues. Although many women are "understandably confused by the mixed messages," they should "remember that the guidelines are just that -- merely advice," it says (Philadelphia Inquirer, 11/20).

Opinion Pieces

~ Robert Aronowitz, New York Times: The recommendation for mammogram screenings begining at age 50 rather than age 40 is "really nothing new," according to Aronowitz, an internist and professor of the history and sociology of science at the University of Pennsylvania. He writes that the guidelines are "almost identical to the position the group held in the 1990s" and that the debate has been ongoing since a 1971 study found that mammography only had lifesaving benefits for women older than age 50. Critics of the new recommendations "generally sidestep the question of whether the very small numbers of lives potentially saved by screening younger women outweigh the health, psychological and financial costs of overdiagnosis," Aronowitz says, adding that screening 1,900 women in their 40s for 10 years would prevent one death and cause more than 1,000 false-postives (Aronowitz, New York Times, 11/20).

~ Douglas Kamerow/Steven Woolf, Washington Post: In the opinion piece, Kamerow -- a former assistant attorney general who is now chief scientist at RTI International
and a professor at Georgetown University -- and Woolf -- a professor at Virginia Commonwealth University -- write that they "have worked with the task force in many capacities over the years" and want to dispel "some myths about the panel and try to put the recommendations into context." First, Kamerow and Woolf note that "the panel is independent" and "does not speak for the government or dictate health insurance coverage policies." The task force recommendations "are not related to costs, saving money or rationing care," they add. The task force "is not against women getting mammograms in their 40s" but "simply wants women in that age range and older to discuss the risks and benefits with their doctors before they get tested," which is a position "[n]o one should be against," the authors conclude (Kamerow/Woolf, Washington Post, 11/20).

~ Steven Pearlstein, Washington Post: HHS Secretary Kathleen Sebelius "did a marvelous job this week of undermining the move toward evidence-based medicine with her hasty and cowardly disavowal of a recommendation from her department's own task force that women under 50 are probably better off not getting routine annual mammograms," columnist Pearlstein writes. Pearlstein continues, "The better approach would have been to see this as one of those teachable moments that could be used to reaffirm the entire rationale for reform." While debate about whether some women receive too many mammograms continues, "there is evidence that there are women who, because they lack insurance, are getting too few -- and dying unnecessarily as a result," Pearlstein writes. He adds that "correcting that imbalance" is a central goal of health reform and that "[p]ut in that context, it would have been perfectly reasonable for Sebelius to have announced that she was delaying implementation of the task force recommendation for a year in order to give it more time to seek a broader consensus among researchers, doctors and patients" (Pearlstein, Washington Post, 11/20).

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