Angry radiology groups are blasting a government panel's recommendations that women ages 40 to 49 forgo annual screening mammograms and that women between age 50 and 74 should have screening mammograms only once every other year rather than annually.
The U.S. Preventive Services Task Force review of literature advises that women over age 74 should stop all breast cancer screening because the practice lacks evidence of clinical benefit, and found that breast self-examination "does not reduce breast cancer mortality." The task force also noted the increased risk of false positives and other kinds of harm that result from medical overtreatment of abnormal findings that would never have caused death.
But officials for the Access to Medical Imaging Coalition (AMIC) and the American College of Radiology immediately jumped on the task force guidelines, calling them "shocking" and an attempt to "ration care." They said that if incorporated into reimbursement policies by government insurers and payers, many avoidable breast cancer deaths will occur.
"Two decades of decline in breast cancer mortality could be reversed and countless American women may die needlessly from breast cancer each year," according to a statement from the ACR. "Mammography is not a perfect test, but it has unquestionably been shown to save lives—including in women aged 40-49," said Carol H. Lee, MD, ACR chair.
"They say it's not cost efficient. Well, we're not comfortable putting a price tag on a woman's life," added Shawn Farley, ACR spokesman. Besides, he said, the typical mammogram reimbursement from Medicare is only $89. "That's one of the reasons why this (recommendation) is so perplexing."
W. Phil Evans, MD, president of the Society of Breast Imaging, said, "These recommendations are inconsistent with current science and apparently have been developed in an attempt to reduce costs."
"To tell women they should not get regular mammograms starting at 40, when this approach has overwhelmingly been shown to save lives, is shocking," Evans said. "At least 40% of the lives saved by mammographic screening are of women aged 40-49."
If the task force's recommendations are adopted in payment policies by the Centers for Medicare and Medicaid Services and private insurers, millions of dollars in billable tests would not be performed, hitting the imaging industry at a point when it is already absorbing reimbursement cuts from CMS.
A statement from the Access to Medical Imaging Coalition (AMIC), which represents physicians, equipment manufacturers, patient groups, and those who develop imaging technology, said the guidelines seem to go against President Barack Obama's stated goals to increase efforts in early disease detection.
"Unfortunately, Medicare has already refused to cover new technologies to increase the detection of colon cancer, is cutting payments for advanced diagnostic tests such as MRI of the breast by 50%, and now the USPSTF is paving the way for insurers to deny mammography coverage," said Tim Trysla, AMIC executive director.
"This type of policy, which puts millions of women of all ages at risk, is contrary to the evidence and the President's own words, makes no sense, and should be rejected," he said.
The recommendations were issued in a paper published today in the Annals of Internal Medicine, the journal of the American College of Physicians, and was published by the Agency for Healthcare Research and Quality.
The guidance represents a significant departure from the task force's recommendations from 2002, which suggested mammography screening—with or without clinical breast examination—every one to two years for women 40 years of age or older.
They also go against recommendations from the American Cancer Society on breast cancer screening.
The task force's 16 members are appointed by the U.S. government and work with the Agency for Healthcare Research and Quality to review the evidence of effectiveness and develop recommendations for clinical preventive services.
The task force's review concluded there's inadequate evidence that more frequent mammography carries life-saving benefits. Rather, it concluded, potential harm from screening may result, including "psychological harms, unnecessary imaging tests and biopsies in women without cancer, and inconvenience due to false-positive screening results."
The task force also referred to "the harms associated with treatment of cancer that would not become clinically apparent during a woman's lifetime (overdiagnosis), as well as the harms of unnecessary earlier treatment of breast cancer that would have become clinically apparent, but would not have shortened a woman's life. Radiation exposure (from radiologic tests), although a minor concern, is also a consideration."
The task force said women who are at high risk for breast cancer and are between the ages of 40-49 should talk with their doctor about the best time to start regular, biennial screening mammography.
Among other highlights of its report, the task force said there isn't enough evidence to assess benefits or harms of digital mammography or magnetic resonance imaging instead of film mammography.