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Mammography Screening Message Was Misunderstood, Says Task Force

Janice Simmons, for HealthLeaders Media, December 3, 2009

The message relayed last month by the U.S. Preventive Services Task Force (USPSTF) about screening mammographies for women under 50 was misunderstood because of the way it was written, two of the group's members told a House panel on Wednesday.

As initially published at its Web site, the USPSTF stated in its new breast screening guideline that it "recommends against routine screening mammography in women aged 40 to 49 years." The panel's suggestion was bashed throughout the country for what was perceived as rationing care or putting costs before health.

But that wasn't quite the message it was trying to get across, Diana Petitti, MD, MPH, the USPSTF vice chair, told the House Energy and Commerce Health Subcommittee Wednesday. Instead, it should have emphasized the second sentence in that recommendation: "The decision to start regular biennial screening before the age of 50 should be an individual one and take patient context into account—including patient's values regarding specific benefits and harms," Pettiti said.

"That is, the task force is saying that screening at 40 should not be automatic nor should it be denied. Many doctors and many women—perhaps even most women will decide to have mammography screening at age 40. The task force supports those decisions," she said.

"The task force acknowledges that the language used to describe its 'C grade' recommendations about breast cancer screening for women 40 to 49 did not say what the task force meant to say. The task force communication was poor," she added. The "C grade" refers to the ranking by the task force that a patient can be informed of harms and benefits, but the patient is responsible for making the decision to be tested.

In his opening statement, Energy and Commerce Committee head Henry Waxman (D-CA) said that he did believe that the task force, in its review of its 2002 mammography guidelines, was trying "to take a fresh look of what has been learned over the last several years, and based upon that body of work, to provide its best professional judgment on what doctors and their patients should consider when they are making decisions about breast cancer screening."

"While that judgment may be contentious, I have no doubt it was driven by science and by the interpretation of science—and not by cost or insurance coverage or the ongoing health reform debate," he said.

Petitti agreed with Waxman. "Cost played no role in our recommendations," she told the panel.


Janice Simmons is a senior editor and Washington, DC, correspondent for HealthLeaders Media Online. She can be reached at jsimmons@healthleadersmedia.com.

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