AMA Bucks USPSTF on Mammography

June 19, 2012— -- CHICAGO -- The American Medical Association's House of Delegates has come out in support of routine screening mammography for women starting at age 40.

The new policy is in direct conflict with the controversial 2009 recommendation of the United States Preventive Services Task Force (USPSTF) that routine screening mammography for breast cancer was unnecessary in women younger than 50.

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The House of Delegates stopped short of recommending that "every woman should get routine screening mammograms every year starting at age 40". Strongly debated in Tuesday morning's session, that language was rejected by the delegates in favor of a lighter "should be eligible" phrasing.

In a further slap at the federal task force, the House of Delegates voted to adopt a resolution stating that the AMA "expresses concern regarding recent recommendations by the USPSTF on screening mammography and prostate specific antigen (PSA) screening and the effects these recommendations have on limiting access to preventive care for Americans."

The firestorm that followed the USPSTF recommendations attracted congressional attention from legislators and HHS secretary Kathleen Sebelius eventually issued a statement emphasizing that the USPSTF does not set health policy.A number of medical groups, including the American Cancer Society, the American College of Radiology , and the American Congress of Obstetricians and Gynecologists disagreed with the USPSTF recommendations and said women younger than 50 benefit from having routine mammograms.

The USPSTF again set off a controversy in 2011 when it said that healthy men do not need prostate cancer screening with prostate specific antigen (PSA) because the test does not save lives and often leads to unnecessary testing, interventions, and treatment. The conclusion came after the USPSTF reviewed data from five large randomized clinical trials of PSA testing, which all found found no mortality benefit among men who underwent screening PSA testing and were followed for 10 years.

The PSA recommendation has been controversial in the medical community, especially after a major European trial showed routine testing in healthy men resulted in about a 21% reduction in the rate of prostate cancer deaths after 11 years of follow-up.

In both instances, speciality medical societies were not happy that they weren't involved in drafting the cancer screening guidelines, and on Tuesday, the AMA adopted another policy encouraging the USPSTF to implement procedures that "allow for meaningful input" from specialists.

The USPSTF is an independent panel 16 volunteer members, most of whom are clinicians in primary care or preventive medicine.