The uproar in the medical community was immediate. In a reversal of standard practice that bewildered physicians and patients around the nation, an independent government panel this week abandoned its long-standing recommendation that healthy women over age 40 get a breast-cancer screen once every year or two years. The U.S. Preventive Services Task Force began advising women instead to delay regular screening until age 50, and even then, to get tested only every other year.
The American Cancer Society promptly declared it would not modify its guidelines that healthy women over 40 get yearly mammograms. Secretary of Health and Human Services Kathleen Sebelius stated that the government’s “policies remain unchanged.” And most physicians say they will continue to recommend annual mammograms for women over 40. Meanwhile, thousands of women across the country have been left confused and anxious.
Members of the government panel expected a backlash, but the magnitude of the public response was a revelation. “It’s surprising to me not only the amount of reaction but the emotionality and the degree to which this has caused upset,” says Dr. Diana Petitti, vice chair of the task force.
The 16-member panel found that yearly mammograms unquestionably reduced the risk of dying from breast cancer 15% in women under 50. But when weighed against the risks of screening — false positives, additional biopsies and patient anxiety — the relative benefit was too small to recommend screening in younger women. That conclusion has incensed some oncologists. “They are saying that we should take mammography away from women in their 40s because … these factors outweigh the value of lives saved,” says Dr. David Dershaw at Memorial Sloan-Kettering Cancer Center.
Given the backdrop of health care reform and insurers’ preoccupation with cost containment, the major concern is that women under 50 may now stand to lose insurance coverage for mammography — a preventive test that Medicare is mandated to pay for. But Sebelius rejected the notion. The task force does not “set federal policy, and they don’t determine what services are covered by the Federal Government,” she said. On the part of the task force, Petitti says the cost of mammography was never mentioned in the panel’s discussions.
Still, if confused and frustrated women begin opting out of screening altogether, changing guidelines could erode progress that has been made in reducing breast-cancer deaths. Says Dr. George Sledge, president-elect of the American Society of Clinical Oncologists: “If the end result of all of this were to diminish the number of women having mammograms, then that would be a tragedy.”
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