GOP: Mammography Recommendations a Sign of Things to Come

WASHINGTON, Nov. 22, 2009— -- Controversial new breast cancer screening recommendations are being used as a political football in the health care debate, with Republicans calling them an example of the type of government "rationing" and control over individuals' health decisions that would take place if Democrats succeed in passing a health care reform bill.

"The guidelines that came out this week by the Preventive Services Task Force have a direct link to what would be offered if the House and the Senate bills were to go into law," Rep. Marsha Blackburn, R-Tenn., said Sunday on ABC's "This Week".

The USPSTF guidelines issued last week recommend "against routine screening mammography in women aged 40 to 49 years."

"For biennial screening mammography in women aged 40 to 49 years, there is moderate certainty that the net benefit is small," the USPSTF concludes, stating that women in that age range commonly have "false-positive" screening results that can lead to overdiagnosis, psychological harm, unnecessary imaging tests and biopsies in women without cancer.

The decision to start routine screening mammography before the age of 50 years should be "an individual one and take patient context into account, including the patient's values regarding specific benefits and harms," the task force's recommendations summary said. The recommendations were published in the November 2009 issue of the Annals of Internal Medicine.

"This is how rationing begins. This is the little toe in the edge of the water," Blackburn said last Wednesday, at a press conference on Capitol Hill. "This is when you start getting a bureaucrat between you and your physician. This is what we have warned about."

Yet, many Democrats say they also disagree with the recommendations by the U.S. Preventive Services Task Force, and that there is no requirement in their health care overhaul bills that would force women or their doctors to follow them.

Democrats Say Recommendations Aren't Binding

"They aren't controlling," said Rep. Debbie Wasserman-Schultz, D-Fla. on ABC. "They aren't going to be binding. They're recommendations."

Wasserman-Schultz, who is a breast cancer survivor, said she is against the recommendations.

And last Wednesday, HHS Secretary Kathleen Sebelius told women to ignore the recommendations.

"The U.S. Preventive Task Force is an outside independent panel of doctors and scientists who make recommendations. They do not set federal policy and they don't determine what services are covered by the federal government," Sebelius said in a written statement. "I would be very surprised if any private insurance company changed its mammography coverage decisions as a result of this action."

Yet, according to language in the current Senate health care reform bill under consideration, only services rated an "A" or "B" by the USPSTF would be covered by a group health plan and health insurance issuers. Under the new recommendations, mammography for women in their 40s is rated a "C."

Former NIH Head Calls Recommendations 'Hidden' Rationing

On Sunday, the former head of the National Institutes of Health Dr. Bernadine Healy advised women to ignore the new mammography recommendations and continue getting screened for breast cancer in their 40s.

"I'm saying, very powerfully, ignore them," said Healy on "FOX News Sunday." "Women in their 40s have a very aggressive kind of breast cancer. They tend to progress fast. And to not screen women in that age group is astounding to me, and it goes against the bulk of individuals who are actually caring for patients," Healy said.

Healy called the recommendations "hidden government rationing", since the USPSTF is sponsored by the research arm of the Department of Health and Human Services, even though it is an independent panel consisting of private-sector experts in prevention and primary care.

USPSTF's mission includes making "recommendations about which preventative services should be incorporated routinely into primary medical care and for which populations," according to its Web site.

"The issue here is that we are listening to one voice. And unlike what the secretary [Sebelius] said . . . this is not just a recommendation. This is codified in law that this is the group that will be providing information," she said.

"I think you could get the answer you want and the orientation you want depending upon who was on the task force," said Healy, who served as an adviser to Presidents Ronald Reagan, George H.W. Bush and George W. Bush.

The debate among health professionals over the benefits of mammography testing for breast cancer dates back to more than 40 years. Since then, scientists have disagreed over whether there was significant benefit for women aged 40 to 49 undergoing mammography. In 2002, the USPSTF issued a "B" recommendation for screening mammography for women 40 years or older.