The breast cancer screening recommendations proposed by the U.S. Preventive Services Task Force earlier this week are basically unchanged from the 2009 version.
WARNING: a reader’s yawn at this juncture would be misplaced.
The recommendations proposed and put in place five years ago were so politically radioactive that they could have jeopardized the passage of the Affordable Care Act.
Indeed, the ACA specifically excluded the task force’s 2009 recommendation on mammography.
Immediately after the 2009 draft recommendation was published, then HHS Secretary Kathleen Sebelius in effect urged women between 40 and 49 to disregard the panel’s evidence-based guideline. An amendment to the ACA, called the “Women’s Preventive Health Amendment,” finished the job of invalidating the guideline. (This made the ACA politically viable.)
As a firestorm ignites around the U.S. Preventive Service Task Force draft recommendation on mammography, researchers and advocates are grappling with the questions at the heart of the controversy:
• Should women start screening for breast cancer at age 40 or 50?
• What is the prevalence of false-positives and overdiagnosis in these age groups?
• What are the costs of harm?
The USPSTF draft recommendation, published April 20, comes on the heels of a controversial study which estimates that the
U.S. spends $4 billion a year on unnecessary mammograms for women between the ages of 40 to 59.
Mandl: Costs of Harm from Mammography Must Be Balanced Against Benefits
The U.S. spends $4 billion on unnecessary mammograms each year, according to a study published in the April issue of Health Affairs.
Titled “National Expenditure for False-Positive Mammograms and Breast Cancer Overdiagnoses Estimated at $4 Billion a Year,” the study, by Kenneth Mandl and Mei-Sing Ong, uses expenditure data from a major U.S. health care insurer for 702,154 women in 2011 to 2013.
Of the $4 billion, $2.8 billion is attributed to false-positive mammograms, and $1.2 billion to breast cancer overdiagnosis. The study measures the rate of false positives at 11 percent and overdiagnosis at 22 percent.
Wender: Mammography Guidelines Should Balance Benefits and Risks, Not Costs
“Let me be really clear: I don’t think that article should have or will have any impact on the [US Preventive Services Task Force], and it will not have any impact on [the American Cancer Society] guidelines, either,” Wender said.
Four Decades of Mammography Wars
The latest draft guideline by the U.S. Preventive Services Task Force is part of nearly a four-decade war over the appropriateness of screening women between the ages of 40 and 49.
In this war, Congress usually intervened, claiming that “common sense” dictates that mammography is efficacious in younger women. This war has often engulfed NCI.
This timeline appeared in part in the Nov. 20, 2009, issue of The Cancer Letter.
|AACR Annual Meeting 2015|
Jose Baselga becomes president of AACR
Two Stand Up To Cancer Dream Teams launched in ovarian and lung cancer
Multiple award winners named
The Cancer Letter Receives Sigma Delta Chi Award
The Cancer Letter won a 2014 Sigma Delta Chi Award for Public Service in Journalism from the Society of Professional Journalists on April 23.
The Sigma Delta Chi Awards is a national competition dating back to 1932. The award recognizes Matthew Ong’s series “Power Morcellation: A Hazardous Practice” as the winner in the Newsletter category.
“This award recognizes a newsletter that renders outstanding public services through extensive coverage of an issue facing the community it serves,” the description reads.
Ong’s series, which includes an interview documentary, can be found here.