The U.S. Preventive Task Force is under fire this week after it issued new clinical guidelines recommending that women 40-49 forgo annual mammograms unless they have certain risk factors, like genetic mutations that make them more susceptible to breast cancer. The task force also said self-exams are useless and recommended women over 50 get mammograms every other year – not every year. The panel also said a review of clinical data showed that yearly mammograms for women 40-49 reduced the risk of breast cancer death by 15%, but under a section titled “Balance of Harms and Benefits,” said this:
Harms of screening include psychological harms, additional medical visits, imaging, and biopsies in women without cancer, inconvenience due to false-positive screening results, harms of unnecessary treatment, and radiation exposure. Harms seem moderate for each age group.
False-positive results are a greater concern for younger women; treatment of cancer that would not become clinically apparent during a woman’s life (overdiagnosis) is an increasing problem as women age.
These new guidelines – which while influential, are not binding – have caused no small amount of consternation. Women are incensed that some faraway task force has decided a 15% risk reduction – i.e. actual lives saved – is not enough to warrant mass screenings. I asked a number of female colleagues here at TIME what they thought of the new guidelines and all said they found the new recommendations to be disturbing. One even said the news set off “a giant pink bell ringing in my head.”
Some Republicans in Congress are using the task force recommendation to sound the warning call for looming health care rationing. Republican Sen. Mike Enzi issued a press release late Wednesday with this ominous intro: “A government task force has recommended women should not receive regular mammograms until they are 50. Is that a sign of things to come?” Republican Congresswoman Marsha Blackburn told CNN, “This is how rationing begins,” calling the mammogram guidelines “the little toe in the edge of the water. And this is where you start getting a bureaucrat between you and your physician.”
Democrats, perhaps sensing the risk of another death panel-like incident, fired back. Democratic Congresswoman Rosa DeLauro released a statement accusing political opponents of “Republicans’ political gamesmanship.” Health and Human Services Secretary Kathleen Sebelius, seeking to distance herself from the new guidelines, released a statement saying, “My message to women is simple. Mammograms have always been an important life-saving tool in the fight against breast cancer and they still are today. Keep doing what you have been doing for years — talk to your doctor about your individual history, ask questions, and make the decision that is right for you.” White House Deputy Communications Director Dan Pfeiffer wrote a blog post titled “Reality Check: Beware What “Critics Say” on Reform and Mammograms,” with a question and answer format addressing the controversy.
But in the case of Democratic Rep. Debbie Wasserman-Schultz, experience trumped politics. The congresswoman was diagnosed with breast cancer at age 41 and said she was offended at the guidelines, telling CNN they were “irresponsible,” and adding, “It’s a very patronizing attitude that these scientists have taken…It’s pretty outrageous to suggest that women couldn’t handle more information.”
As easy at it will be to turn these new recommendations into a political shouting match with Republicans saying this is tantamount to “government getting in between you and your doctor” and Democrats claiming the guidelines mean nothing, these new recommendations actually get to the heart of what health care policy is really about – patients and money.
For instance, a small number of women get diagnosed with breast cancer in their 20s and 30s. Does this mean mammograms should be routine during these years too? At what point do lives saved outweigh “psychological harms, additional medical visits, imaging, and biopsies in women without cancer, inconvenience due to false-positive screening results, harms of unnecessary treatment, and radiation exposure.” Will private insurance companies, which pay close attention to guidelines from the U.S. Preventive Task Force and other groups, stop covering mammograms for women under 50? Wouldn’t insurers rather catch cancers early when they are easy (and cheap) to treat? And what about the oft-touted U.S. breast cancer five-year survival rate, which is 83.9%, compared to England, where it’s 69.7%?
I’ll be exploring these questions and more in an upcoming Time.com story. For reaction from the medical community, here are some recent stories from TIME’s Alice Park and Tiffany Sharples O’Callaghan.