Final Mammogram Recommendations Perpetuate Confusion, Debate

by Amanda Conschafter, blog editor

The U.S. Preventive Services Task Force has issued final guidance on how often and at what age women should receive mammograms to screen for breast cancer. Women should begin mammograms at age 50, the USPSTF recommendations say, and continue every other year until age 74. Yet contrary guidance from several cancer organizations leaves some patients perplexed. Meanwhile, USPSTF’s stance perpetuates debate among health care providers and policymakers about risk, access and transparency.

USPSTF Recommendations

Final USPSTF guidance largely reaffirms advice issued by the task force in 2009, when the group first suggested pushing the starting age for mammograms back from age 40 to age 50. The 2009 guidance also recommended screening every other year, a break from previous guidance that encouraged annual testing. Those changes prompted uproar in the medical community and among patient advocates, who worried that delayed diagnoses would result in more cancer deaths.

In the 2016 guidance, task force members acknowledge the value of beginning screening at age 40 for some women, explained task force vice chair Kirsten Bibbins-Domingo. She noted, “The science absolutely supports the benefit of screening in their 40s, but the likelihood of benefit is less for women who are younger.”

Effect on Patient Access

Beyond influencing views on breast cancer screening, the task force guidelines have real-life implications for patient access. The Affordable Care Act requires that private health plans cover preventive services recommended by the task force—with no patient cost-sharing.   In the case of breast cancer, President Obama signed the Protecting Access to Lifesaving Screenings Act in December 2015, requiring health plan coverage for mammograms from age 40. The bill’s protections extend through 2017. At that point, health plans could choose to limit mammogram coverage to reflect the USPSTF’s final guidance.

Task Force Transparency

Controversial guidance raises concerns among some about the process and power of a group whose recommendations have such an impact on patients. Task force members are primary care and preventative medicine professionals appointed to the group by the director of HHS’ Agency for Healthcare Research and Quality. Members are not subject to a congressional appointment process, despite the weight of the task force’s recommendations.

In 2015, Rep. Marsha Blackburn (R-Tenn.) and Rep. Bobby Rush (D-Ill.) introduced the U.S. Preventive Services Task Force Transparency and Accountability Act, which would require the task force to publish research plans, make recommendations available for public comment and establish a system for grading preventive care. The bill would also create a stakeholders board to provide feedback to the task force.

Confusion & Consensus

Varying advice continues to confuse patients about the best course of preventive treatment. The American Cancer Society published revised guidelines in October 2015 recommending that women begin annual screenings at age 45. The American Congress of Obstetricians and Gynecologists and the National Comprehensive Cancer Network recommend annual screenings beginning at age 40.

The ACOG holds a consensus conference this month with the hopes of developing “a consistent set of uniform guidelines for breast cancer screening that can be implemented nationwide.”

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