Which Hospitals Are Ignoring New Mammogram Rules?

Task force members aren't surprised that doctors ignored the new guidelines.

LAUREN COX<br>ABC News Medical Unit

November 18, 2009, 7:21 PM ET

7 min read

Nov. 19, 2009— -- New recommendations for breast cancer screening that brewed a storm of controversy and confusion were formally rejected Wednesday by the Obama administration and by medical centers across the country.

In less than 48 hours, ABC News learned of 42 medical centers who said either through statements, Internet postings or interview comments by leading mammography experts that they had rejected the recommendations by the task force.

The list of medical centers that told women they are not adopting the task force recommendations included major centers from every area of the country: Johns Hopkins, University of Pittsburgh, Duke Medical Center, MD Anderson, Mayo Clinic and UCLA.

"The study released by the United States Preventive Services Task Force will not change current practices at Johns Hopkins," reads a statement Johns Hopkins Medicine posted on its Web site. "We will maintain our recommendations that routine screening for women at average risk for cancer occurs annually from 40 years of age through 80, when it can be altered at that point... please continue to schedule your mammograms annually, check your breasts, and let your physician know when changes occur."

In a statement issued by Dr. Edward Partridge, director of the University of Alabama at Birmingham (UAB) Comprehensive Cancer Center, he said his institution "strongly supports the recommendations of the American Cancer Society that women should begin mammography screening at age 40 and continue on an annual basis as long as they are in good health."

Keep reading for a list of medical centers that are not following the new breast cancer screening guidelines.

Meanwhile, Health and Human Services Secretary Kathleen Sebelius distanced the Obama administration from the recommendations that women begin mammography at age 50. Sebelius told women confused by the recommendations, which run counter to nearly all major cancer organizations to "keep doing what you are doing. "

"[T]he task force has presented some new evidence for consideration, but our policies remain unchanged," Sebelius said in a statement issued Wednesday afternoon. Sebelius also reminded women that the USPSTF "[does] not set federal policy and they don't determine what services are covered by the federal government."

Members of the USPSTF that made the recommendations tell ABC News they're not surprised doctors don't want to change current screening practices, but that plenty of misinterpretations and falsehoods have clouded the purpose of Monday's guidelines.

The clashing recommendations may leave some women confused, particularly low-risk women in their 40s to whom the changes in guidelines most directly apply.

Why Would Doctors Ignore the Guidelines?

"In general, it takes 17 years to translate findings in research into clinical practice," said Bernadette Melnyk, a professor at Arizona State University and a member of the USPSTF.

In fact, Melnyk said that the breast cancer screening recommendations aren't the only advice from USPSTF that doctors ignore. The USPSTF issues guidelines on a range of topics and "a lot of providers still don't follow them and they still don't use them.

"We estimate that only 10-15 percent of health care decisions are currently evidence-based," said Melnyk. "We are a long way off using the best evidence we have and putting that into practice."

Resistance to New Breast Cancer Screening Guidelines Abounds

Doctors weren't the only ones up in arms. Plenty of activists, politicians and bloggers have taken issue with Monday's recommendations that also double the time between routine mammograms for women over age 50 to once every other year.

In this case, Melnyk and another member of the task force say the reaction may be due to misinterpretations than professional disagreements about the guidelines.

What's Misunderstood About the Guidelines?

"I think what everybody needs to understand is that our recommendation is not a recommendation against screening women in their 40s,"said Melnyk. "It's recommendation against routine screening starting at age 40."

In other words, Melnyk said women should not start getting mammograms automatically when they turn 40, but instead talk with their doctors about their personal risks for breast cancer to see if a mammogram is warranted.

She said one of the biggest misperceptions "is that the United States Preventive Task Force is a government agency. We are not. We are not hired by the government to put out these recommendations. We are truly a group of independent experts," said Melnyk.

Task force member Dr. Timothy Wilt said the motivations behind the recommendations have also become a point of confusion and charges of health care rationing.

"There are some individuals who don't like the message and they want to turn it into a message of access and cost," said Wilt, of the Minneapolis Veterans Affairs Medical Center in Minnesota.

However, Wilt said the task force did not consider cost or insurance at all in their recommendations. Instead he hoped the recommendations would represent the best analysis of the harms versus benefit equation in breast cancer screening.

What's So Harmful About A False Positive?

Wilt also pointed out that the task force believes there are serious harms in the practice of giving mammograms to every woman in her 40s, regardless of her risk for breast cancer.

For example, 100,000 women in their 40s are screened. "That means that there will be 5,000 biopsies which cause some pain and additional anxiety and additional radiation associated with additional testing."

However, at least in the first week, the guidelines have caused more anxiety for doctors and patients confused by the guidelines.

Dr. Susan Boolbol of the Beth Israel Medical center in New York had one patient cancel a lumpectomy this week because she mistook the task force's guidelines on screening as a free pass for women in their 40s.

"In light of the article about mammograms and "overtreatment" of breast cancer, this patient had decided to forego a surgery. She believes that removing this [cancerous] area is too radical a treatment," Boolbol told ABC News. "It is difficult for the lay person to fully understand what these studies really mean and how decisions about recommendations and guidelines are made."

Below is a list of medical centers that told ABC News they will stick with current guidelines recommending breast cancer screenings begin at age 40. Click the links below to read their statements.

Barbara Ann Karmanos Cancer Center, Mich.