Reston, Va. — If cost-cutting U.S. Preventive Services Task Force (USPSTF) mammography recommendations are adopted as policy, two decades of decline in breast cancer mortality could be reversed and countless American women may die needlessly from breast cancer each year. The recommendations ─ created by a federal government-funded committee with no medical imaging representation ─ would advise against regular mammography screening for women 40-49 years of age, provide mammograms only every other year for women between 50 and 74, and stop all breast cancer screening in women over 74.
“These unfounded USPSTF recommendations ignore the valid scientific data and place a great many women at risk of dying unnecessarily from a disease that we have made significant headway against over the past 20 years. Mammography is not a perfect test, but it has unquestionably been shown to save lives ─ including in women aged 40-49. These new recommendations seem to reflect a conscious decision to ration care. If Medicare and private insurers adopt these incredibly flawed USPSTF recommendations as a rationale for refusing women coverage of these life-saving exams, it could have deadly effects for American women,” said Carol H. Lee, M.D., chair of the American College of Radiology Breast Imaging Commission.
Since the onset of regular mammography screening in 1990, the mortality rate from breast cancer, which had been unchanged for the preceding 50 years, has decreased by 30 percent. Ignoring direct scientific evidence from large clinical trials, the USPSTF based their recommendations to reduce breast cancer screening on conflicting computer models and the unsupported and discredited idea that the parameters of mammography screening change abruptly at age 50. In truth, there are no data to support this premise.
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> Although USPSTF states that their recommendations were not motivated by cost savings, based on the above, we cannot help but draw the conclusion that the taskforce recommendations amount to rationing on the basis of financial costs. The USPSTF’s analysis evaluates the number of lives lost under a variety of screening scenarios and then blatantly recommend the most “efficient” (i.e. less expensive) screening interval, not the one that saves more lives. Not only are these numbers based on the lowest estimate of benefit, but they have no meaning for the women being screened. Each woman has a single screening study each year regardless of the yield of cancers. Numbers only suggest the relative “cost” of curing a cancer by early detection and the USPSTF has, arbitrarily, decided that the cost of saving women ages 40-49 is too high.
USPSTF Selectively Reviewed the Literature, Ignoring Hundreds of Well-Regarded Studies on the Subject
> The taskforce commissioned its own computer models that had never been subject to critical peer review, ignoring previously published computer modeling studies and direct scientific evidence from large clinical trials that contradict their conclusion. The recommendations also ignored peer reviewed journal articles that critiqued studies on which their recommendations rely. They did not consider literature that didn’t evaluate mortality as an endpoint.
> Notably, the USPSTF does not even mention the actual published data from Sweden and the Netherlands that directly show what happens when new therapies and mammography are introduced into the population. These studies demonstrate that it is mammography screening and not new therapies or practices that are responsible for most of the decrease in deaths over the past 20 years.
> The fact that hundreds of respected journal articles were ignored while another trial was translated from Russian to English for consideration by the taskforce makes the entire literature review suspect.
The fact that hundreds of respected journal articles were ignored while another trial was translated from Russian to English for consideration by the taskforce makes the entire literature review suspect.
> The elaborate academic exercise that the taskforce conducted is obviated by one important truth – almost universally, clinicians will agree that breast cancer therapy is far more successful when the cancer is found at a smaller size and earlier stage by mammography. In Sweden mammography screening has decreased breast cancer deaths among women in their 40’s by over 40 percent.
> The taskforce makes assumptions that are contrary to the evidence. For example, the presumption that loss of life can be minimized if “high risk” women opt to be screened earlier or more frequently than recommended, overlooks the fact that about 75 percent of all breast cancers occur in women who are not at high risk.
> The taskforce ignored literature describing survey results that women prefer to experience false-positives if the overall result is finding additional cancers in the screened population.
