April 21, 2015
Yesterday the United States Preventative Services Task Force (USPSTF) released a draft update to their recommendations on screening for breast cancer for which they are currently taking public comments through May 18, 2015. Ultimately the draft update does not stray from their previous recommendations and includes their “inconclusive findings” on 3-D Mammography and recommendations for women with dense breast tissue. The draft update also does NOT include data and information gained from more modern studies and ultimately puts current coverage for annual screenings at risk, as well as thousands of women’s lives.
The Task Force aims to update their recommendations every five years. The previous update was in 2009 when they changed the recommendations to suggest biennial screening mammography for women ages 50-74. Those recommendations came under immediate and harsh criticism from major cancer and radiology organizations, as well as breast cancer survivors and women across the country. Analysis of their methodology showed that if their recommendations were followed, approximately 6,500 additional women each year in the US would die from breast cancer.
We understand that this USPSTF draft may raise more questions than it answers. So, we wanted to take this opportunity to give you more information. Here are some key points and links:
Links to Key Articles on the USPSTF Updated Recommendations:
• USPSTF Public Comment Link: www.screeningforbreastcancer.org
• ACR Press Release: http://www.acr.org
• SBI/ACR Joint Statement: http://www.sbi-online.org
• American Cancer Society: http://pressroom.cancer.org
• USA Today: http://www.usatoday.com
Diversified Radiology’s Screening Mammography Recommendations:
In alliance with the American College of Radiology, the Society for Breast Imaging and many major cancer organizations, Diversified Radiology strongly recommends women begin their ANNUAL screening mammography routine at age 40, and that women with a family history of breast cancer consult with their primary care physician about when to get their baseline mammogram and if additional imaging is needed.
What does the USPSTF Draft Recommendation Really Mean?
The USPSTF is NOT suggesting that screening mammography is not valuable, only that their Task Force does not see enough benefit to match the recommendations affirmed by many nationally recognized organizations including the American College of Radiology (ACR), Society for Breast Imaging (SBI), American Congress of Obstetricians and Gynecologists and the American Cancer Society. The Task Force’s recommendations to grade the screening as a “C” for women ages 40-49 denotes that the decision to be screened is an individual one. Additionally the Task Force gave a “B” grade to screening women every other year who are ages 50-74, not annually. Unfortunately, the USPSTF grading puts coverage for annual mammograms at risk, as the Affordable Care Act (ACA) only requires private insurers to cover exams given a grade “B” or higher by the USPSTF. The ACR and SBI are calling on the Secretary of the US Department of Health and Human Services to affirm that current coverage of annual mammograms will not be affected.
During this draft period, the USPSTF is accepting public comments through May 18, 2015. You may comment via their site at: www.screeningforbreastcancer.org
The New USPSTF Update Has the Same Flawed Approach:
The USPSTF’s approach to developing a guideline for screening mammography has been, and continues to be seriously flawed. Below is a list of concerns.
• No breast imaging or breast cancer experts were included in the panel or at the meetings. The Institute of Medicine (IOM) has recommendations for screening guideline development that are considered the “gold standard” among the medical community. The USPSTF’s methods did not meet those IOM thresholds to be considered “trustworthy guidelines.” Many in the medical community, including the ACR and SBI, have concerns about the Task Force’s lack of transparency.
• The USPSTF review did NOT include data and information gained from more modern studies that take into account improved mammography techniques and technology, thereby misrepresenting their statements regarding over-diagnosis and harms of mammography. Outdated data has biased the results suggesting greater over-diagnosis rates and also does not take into account the benefits of life-years saved and improved, and sometimes less-expensive, treatment options offered when cancers are detected earlier.
• No direct research was used, but instead the USPSTF used statistics and computer models to estimate screening mammography benefits by various ages. Accepted scientific approaches should include randomized, double-blinded study methods that measure actual outcomes. Research trials that use this gold standard approach reflect a 30% decrease in mortality from breast cancer since 1990 due to screening women 40+ and improved treatments; the National Cancer Institute puts the drop in mortality as high as 35% since the mid-1980s.
• While the USPSTF acknowledges that “evidence shows that mammography screening can be effective for women in their 40’s,” they still chose to give the screening for women in their 40’s a “C” grade, stating that the number of lives saved is smaller and the number of false-positives is higher. Diversified Radiology believes this is an inadequate justification, as cancers in women under 50 are often more aggressive, making screening even more important.
• The USPSTF suggests screening mammography is more beneficial for women 40-49 with a family history (parent, sibling or child); however with 75% of women diagnosed with breast cancer having no family history, we risk the majority of breast cancer going undetected.
• The Task Force also reviewed 3D mammography and concluded there is “not enough evidence to determine whether it will result in improved health or quality of life or fewer deaths among women. Data on mortality takes 20-30 years to gather; so it is too soon to formally assess this for 3D mammography.” However, “accuracy data” is available. Diversified Radiology’s data of 3D mammography reflects a 40% increase in cancer detection over standard 2D mammography. This helps with earlier treatment and greatly improves survival rates. Additionally, with the use of 3D mammography, there has been a 30% reduction in our recall rate, which helps decrease the issue of anxiety of false positives often cited as harmful by the USPSTF.
If you feel strongly about this issue, please share your thoughts with the USPSTF before May 18th by going to www.screeningforbreastcancer.org.