by
Sean Ruck, Contributing Editor | May 27, 2011
From the May 2011 issue of HealthCare Business News magazine
“They [the USPSTF panelists] made recommendations based on science and data, but there are interpretations and value judgments placed on them, so it’s not pure mathematical analysis,” Lee says.
It is important to note that they are just recommendations. What lawmakers decide to do with them is a different story. In this case, the health care reform bill clearly states that routine mammograms must be covered by insurance providers for women 40 and above, but that action isn’t necessarily inconsistent or unsupportive of the panel.
“The task force gave the recommendation a C grade. That meant we still felt the recommendation was valid, but the net benefit is small,” LaFevre explains. “However, I don’t see why any third party provider wouldn’t cover a C recommendation. There is no D against mammo.”
LaFevre also highlights what he believes was the biggest cause of the backlash against the recommendations — phrasing. “We thought the way it was phrased in publication may have contributed to the confusion. We’ve since removed the sentence we felt was causing part of the problem.”
The sentence in question stated, “The task force recommends against routine screening mammography in women aged 40-49 years.” LaFevre says the word “routine” was overlooked or should have been clearly emphasized. He says women with risk factors would not be included under routine screening.
The guidelines have their foundation in reasonable science. LaFevre says in a group of 1000 40-year-old women, about 30 will die from breast cancer if they don’t have screening. “If we screen from 50 to 74, we can reduce that number by seven, which is a pretty good drop in mortality.” He goes on, “If we back that down to 40, we may be able to save one more. It’s not zero, but it’s small.” He also notes that women in their 40s will roughly undergo the about the same number of biopsies as those in their 60s, but the 40-year-olds will have far fewer cases of cancer.
LaFevre is a member of the task force, but also a practicing physician and has his own take on the recommendations. He translates the guidelines to mean for women with no risk factors aged 40 to 49, screening should be discussed. For 50 to 59, encouraged, 60 to 74, strongly encouraged.
Although the task force doesn’t tackle anything beyond 74, he believes its sometimes worth discussing with patients. “Taking off the task force hat, as a professional, family physician and teacher, as a physician, if I’m seeing a healthy, active 70-year-old, I’m likely to suggest they might want to continue screening until at least 80 if not 85, even though there’s insufficient scientific data to currently support that opinion, so it’s an expert opinion, not a task force recommendation.”
