Panelists express concern about effects of new mammo guidelines on healthcare legislation

December 3, 2009

Experts continue to lambast recent recommendations from the U.S. Preventive Services Task Force to cut breast cancer screening from annual to biennial exams and to limit the test to women ages 50 to 74. The experts are primarily concerned with the task force’s ability to influence policy, and thus they continue to assert there are no data to support the recommendations.

Experts continue to lambast recent recommendations from the U.S. Preventive Services Task Force to cut breast cancer screening from annual to biennial exams and to limit the test to women ages 50 to 74. The experts are primarily concerned with the task force’s ability to influence policy, and thus they continue to assert there are no data to support the recommendations.

A scientific panel was convened at the RSNA 2009 meeting on Wednesday to discuss the task force’s recent decision. Panel members included Dr. Phil Evans, president of the Society of Breast Imaging, Dr. Stephen Feig, president-elect of the American Society of Breast Disease, and Dr. Daniel Kopans, a senior radiologist in the breast imaging division at Massachusetts General Hospital. The experts did not present any new data during the panel, but rather reinforced already known information.

The hullabaloo over the UPSPTF recommendations centers not only on what is best for the patient, but how this will affect healthcare legislation and thus reimbursement for screening services. The legislation before Congress states USPSTF’s recommendations will carry strong weight, which could, in turn, affect CMS’s guidelines.

Panel members said they are concerned no mammography screening experts are being consulted regarding recommendations. A possible reason is conflict of interest.

“It’s been stated that radiologists just want to make money. Our conflict of interest is obvious,” Kopans said. “We also have the expertise in the area. I would argue if you have no conflict of interest, you probably have no expertise.”

More than 20 senators wrote to the Senate Health, Education, Labor and Pension Committee asking them to hold hearings on the USPSTF guidelines. Thus far, no date has been set. However, the House Energy and Commerce Committee subcommittee on health held a hearing on the subject Dec. 2.

Diagnostic Imagingpreviously reported views from the American College of Radiology and Society of Breast Imaging stating the USPSTF relied on computer modeling, as opposed to scientific evidence, to form its recommendations. Wednesday’s press conference reiterated ACR’s and SBI’s assertions by presenting in-depth information on scientific studies countering USPSTF’s recommendations.

Panelists cited information from the Gothenburg trial, Malmo trial, and others clearly showing a benefit from screening mammography for women younger than 50.

The task force admits annual mammography screening will save more lives than screening every two years, but ignored the data anyway, Kopans said.

“They talk about unnecessary biopsies and so on, but they don’t seem to worry about unnecessary deaths,” he said.

USPSTF suggests only women at high risk should be screened in their 40s, but there are no data to support mammography screening based on risk, Kopans said.

“Most women who develop breast cancer are not at high risk, so screening only high-risk women will miss 75% to 90% of breast cancers,” he said.

Women at high risk for breast cancer-those carrying the BRCA1/BRCA2 genetic mutation-account for only 10% of the population. Those with a family history of breast cancer are also at increased risk and account for 25% of the population. Putting the numbers together, women at high risk of developing breast cancer account for 10% to 25% of the population, thus a majority of breast cancer will be missed by screening only those at high risk.

When mammography was introduced in Sweden into the general population of women in their 40s, the death rate for these women decreased by 40%, Kopans said.

“Data from Sweden and the Netherlands clearly show most of the decrease in death is due to early detection, with only a small component due to newer therapies. Yet the USPSTF would deny these women access to early detection,” he said.