Diana Petitti: Taking an Evidence-Based Approach to Public Health
But changing the status quo is often easier said than done, as Petitti learned firsthand in November 2009 after the U.S. Preventive Services Task Force released new mammography guidelines. Petitti, who was vice-chairwoman of task force, ended up spending much of her Thanksgiving holiday that year preparing for a Congressional hearing prompted by the fallout the revised recommendations created.
"Certainly it was recognized that they were going to be controversial and it was going to be difficult to make changes to something that was a set of practices that were so widely embraced by advocacy organizations. But the response and reaction was way beyond anything that I anticipated," she says. "I was surprised at the degree of media attention and concern—almost hysteria—about these guidelines."
The original mammography recommendations were fairly vague, says Petitti. The guidelines were to do a mammogram in women age 40 years or older every one to two years.
The new recommendation was much more specific. It said to screen women age 50 to 74 every other year, and for women age 40 to 50 the decision to screen should be based on a discussion with their physician taking into account individual preferences," Petitti explains. In addition, the guidelines said specifically that "we really don't have evidence to make a firm recommendation about screening women over the age of 75," she says.
The backlash to the revised guidelines was immediate. Headlines included "Breast-Screening Advice is Upended," "Breast Exam Guidelines Raise Furor," and "Political Fallout From the Mammogram Maelstrom."
The concern was that the new guidelines, which reversed a longstanding recommendation that women in their 40s automatically undergo an annual or biannual mammogram, would result in increased breast-cancer deaths among women in their 40s who forgo screening. In addition, there was a fear that insurance companies would immediately deny coverage for mammography for women age 40 to 49 who opt to have the test done.
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