Tempest over new mammography guidelines affect health legislation, insurance guidelines

Nov 18 2009

Newspapers across the country featured front-page follow-up stories on new mammogram recommendations today.

The U.S. Preventive Services Task Force -- "which recommended that women in their 40s should no longer get annual mammograms to screen for breast cancer -- sparked an outcry from those who say that the federal government is more interested in saving money than in improving women's health, even though the panel did not consider costs in its analysis," the Los Angeles Times reports. "Some Republicans jumped on the report as the kind of government intervention in medical decisions that Obama's healthcare plan would bring," calling it a "first step" towards rationing care.

"The uproar also provided a likely preview of future battles. A potentially revolutionary improvement in the medical system would almost certainly bring controversy, confusion and uncertainty along with it. Proposed changes to standard medical procedures, even when supported by scientific evidence, almost always challenge someone's expertise and someone's bottom line. And even the most careful scientific evaluations cannot always provide definitive answers on what works best for all patients." But experts say "that leaving the decisions to the marketplace -- as the U.S. healthcare system has done for decades -- has not produced very good results, even for patients" (Levey, 11/18). 

The Washington Post: "Rep. Frank Pallone Jr. (D-N.J.) announced Tuesday that his House health subcommittee will hold hearings on the mammogram issue next month. Other lawmakers from both parties suggested that the task force had been swayed by insurance companies that stand to save money if fewer screenings are performed." It is unclear, however, what the impact of the new guidelines will be in practice. "Forty-nine states require insurers to cover screenings for women 40 and older; Medicare also pays for the procedure… But critics note that under legislation pending in Congress, the panel's guidelines could be used to set standards for what insurance companies would be required to cover" (Eggen and Stein, 11/18).

The New York Times: "...many doctors said Tuesday that they were simply not ready to make such a drastic change. ... The recommendations, issued Monday by a federal advisory panel, reversed widely promoted guidelines and were intended to reduce overtreatment. The panel said the benefits of screening women in their 40s — saving one life for every 1,904 women screened for 10 years — were outweighed by the potential for unnecessary tests and treatment, and the accompanying anxiety. Women considered at high risk should continue to have early screening, the panel said. Several doctors said that while they understood the panel's risk-benefit analysis, their patients would not see it that way. 'My patients tell me they can live with a little anxiety and distress but they can't live with a little cancer,' said Dr. Carolyn Runowicz, director of the Neag Comprehensive Cancer Center at the University of Connecticut. (Belluck, 11/17).

Hartford Courant: "Insurance companies are reviewing the recommendations by the U.S. Preventive Service Task Force, some said Tuesday." Anthem Blue Cross and Blue Shield of Connecticut, Aetna and UnitedHealthcare are so far standing behind annual screenings for women over age 40. Aetna spokesman Ethan Slavin, however, "added that the company will conduct 'a thorough review of the current medical literature and evidence-based guidelines on this topic'" (Sturdevant, 11/18).

Contra Costa Times: "A resounding chorus of outrage among oncologists, radiologists and breast cancer survivors" say  the guidelines "sent prevention efforts and women's health back into the dark ages. 'It's totally outrageous,' said Dr. Harold Marks, who specializes in breast surgery and oncology at Northridge Hospital and said he would ignore the guidelines. 'It's almost like devaluating a woman's life between the age of 40 to 50,' he said. 'It will cost people's lives in that age group'" (Abram, 11/17).