Breast Cancer Screening Policy Won’t Change, U.S. Officials Say
Breast Cancer Screening Policy Won’t Change, U.S. Officials Say
By KEVIN SACK and GINA KOLATA Published: November 18, 2009 WASHINGTON — The Obama administration distanced itself Wednesday from new standards on breast cancer screening that were recommended this week by a federally appointed task force, saying government insurance programs would continue to cover routine mammograms for women starting at age 40.
As the task force recommendations stirred concern among women, and came under fire from lawmakers of both parties, the White House emphasized that they were not binding on either physicians or insurers. Administration officials also fired back against Republicans who argued that the recommendations illustrated the dangers of an expanded government role in medical decision making.
Democrats on Capitol Hill acknowledged that the recommendations, in the midst of negotiations over a health care overhaul, had handed Republicans a vivid new way to raise the specter of rationing.
The issue underscored the political sensitivity of revamping the health care system, and trying to reduce costs, by using science-based protocols to minimize unnecessary procedures and tests. Even as the White House tried to reassure women that the recommendations would have no immediate force, a group of doctors that analyzes new research for the National Cancer Institute said it would include the new guidelines in the information it provides to doctors and the public.
Kathleen Sebelius, the secretary of health and human services, acknowledged in a statement that the recommendations, by the U.S. Preventive Services Task Force, had “caused a great deal of confusion and worry.” Ms. Sebelius then stressed that the task force “is an outside independent panel of doctors and scientists who make recommendations” and who neither “set federal policy” nor “determine what services are covered by the federal government.”
“The task force has presented some new evidence for consideration,” she added, “but our policies remain unchanged. Indeed, I would be very surprised if any private insurance company changed its mammography coverage decisions as a result of this action.”
On the White House blog, Dan Pfeiffer, the deputy communications director, wrote that “women who are currently getting mammograms under Medicare will continue to be able to get them.”
“There are no plans to change that,” Mr. Pfeiffer said.
The Medicare program, which primarily covers those 65 or older but also insures younger people with disabilities, currently pays for annual mammograms starting at age 40. Coverage policies for Medicaid, the shared state and federal health insurance program for low-income people, are set by the states.
Neither Ms. Sebelius nor Mr. Pfeiffer explained why the government would not embrace the recommendations from the task force, which is appointed by Ms. Sebelius’s department. She said only that “there has been debate in this country for years” about the proper age and interval for breast cancer screening.
The task force advised on Monday that most women should not start routine screening until they are 50, as opposed to the current standard of 40. The reason, according to the task force, is that studies show that “the additional benefit gained by starting screening at age 40 years rather than at age 50 years is small, and that moderate harms from screening remain at any age.”
While the downsides of mammography have not received much attention, cancer researchers say they are real and include excess biopsies, unnecessary anxiety and the discovery and treatment of tumors that would not cause problems if let alone.
The task force encouraged younger women with known risk factors for breast cancer, like a genetic mutation, to make individual decisions with their physicians about mammography. It also recommended that women 50 to 74 years old be screened every two years rather than annually. And it discouraged doctors from teaching breast self-examination.
Several Republican women in the House used the new guidelines to highlight what they said were the dangers of increasing the government’s role in health care under the Democratic legislation.
“This is the little toe in the edge of the water,” said Representative Marsha Blackburn of Tennessee. “This is where you start getting a bureaucrat between you and your physician.”
Under legislation in both the House and the Senate, the federal government would devise a package of essential benefits that insurers would be required to offer in standard policies sold through a new government marketplace, or exchange. A new government insurance plan that would be created under the House bill would have to offer the same minimum benefits.
Mr. Pfeiffer responded to Republican criticism by writing that “one of the hallmark tactics from opponents of health insurance reform has been to grab onto any convenient piece of information and twist it into some misguided attack.”
But it was not just Republicans who expressed dismay. Representative Debbie Wasserman Schultz, a Florida Democrat who voted for the health overhaul bill in the House, said she was “very concerned” that the recommendations conflict with those of other authorities, like the American Cancer Society.
“At a time when we are working to reform our health care system to provide greater access to preventative care,” Ms. Wasserman Schultz said in a statement, “these guidelines and the fact that they conflict with many of the recommendations from leading cancer organizations only adds to the confusion that so many women have when it comes to breast health.”
Meanwhile, the physician group that evaluates new research on cancer screening for the National Cancer Institute determined at a meeting in Washington that the task force evidence was important enough to be added to the information it disseminates to doctors and the public.
Members of the group, Physician Data Query, expressed frustration with the politicization of the mammogram debate.
“It seems like the current public controversy is enormously out of proportion,” said Dr. David Ransohoff, professor of medicine at the University of North Carolina.
The group does not make recommendations for the National Cancer Institute, but the institute said on Monday that it would review the new guidelines and then issue a statement. Its current recommendations are for women to have mammograms every one to two years starting at age 40.
One member of Physician Data Query, Dr. Russell Harris, a former member of the Preventive Services Task Force, said one reason the new guidelines recommend that most women not have mammograms in their 40s is that researchers have become more aware of the problem of overdiagnosis: finding cancers that were better off not being found.
When the task force issued guidelines in 2002 calling for regular screening at age 40, Dr. Harris said, there had not been as much research on overdiagnosis and no statistical modeling asking how often women should get mammograms.