Taken to Task
When the USPSTF issued mammography screening draft guidelines, the ACR took action.
Many observational studies have demonstrated the efficacy of women beginning mammography screenings at the age of 40. In addition, organizations such as the ACR and the Society of Breast Imaging have contended that the so-called “downsides” to starting screening at age 40 are overstated. Most instances in which patients may be recalled due to inconclusive findings result in nothing more than another mammogram or ultrasound being performed. Published studies show that anxiety from this process is short lived, has no lasting effects, and pales in comparison to the enormous benefits of catching breast cancer early to reduce mortality.
Despite these benefits, however, in April of this year the U.S. Preventive Services Task Force (USPSTF) released draft recommendations assigning a “C” grade for women ages 40 to 49 receiving biennial mammograms, reserving the “B” grade for biennial mammograms for women ages 50 to 74. Because the Affordable Care Act does not require private insurers to cover screening tests with a USPSTF grade of “C” or lower, many insurers could drop coverage for women in their 40s and limit coverage to every other year for those 50 to 74. This would create a financial barrier to care for many women of screening age and likely result in thousands of unnecessary breast cancer deaths each year.
To counter the recommendations, the ACR took action. In a comment letter submitted during the task force’s open comment period, the ACR outlined several problems with the recommendations, including the total exclusion of breast imagers from the task force’s panel of experts. “The USPSTF panel did not include a single expert in breast cancer diagnosis or care,” reads the comment letter. “This is unreasonable for a guideline with such important implications.” Added to this was a lack of transparency about the decision-making process. Further, it is unclear whether comments from external reviewers were taken into account by the panel and, if they were, which comments were incorporated and which were discounted.
“We don’t think the task force is doing a service to women by putting out recommendations like these,” says Debra L. Monticciolo, MD, FACR, chair of ACR’s Commission on Breast Imaging. Monticciolo is critical of the task force’s process, which she calls opaque. “We’ve asked them to engage us and to listen to some of our concerns,” she notes. “We’re not asking them to accept everything because we know that nothing is perfect. But we thought they’d at least seek the input of people who are knowledgeable in breast cancer care.”
In addition to the comment letter, the ACR took other measures to express its disapproval: the College issued a letter directly to President Obama and Secretary of the Department of Health and Human Services Sylvia Burwell. The ACR also worked with Members of Congress and their staff in facilitating a letter signed by several high-ranking members of Congress addressed to Secretary Burwell. A separate a letter signed by members of the GOP Doctors Caucus to Secretary Burwell expresses similar concerns. The ACR supplemented these efforts by making the recommendations a major talking point during ACR 2015®, when over 600 College members advocated on Capitol Hill. In particular, members raised concerns with the 2009 and 2015 USPSTF process and recommendations related to breast cancer screening. They urged their Congressional representatives to support USPSTF transparency legislation that is currently making its way through Congress.
If the draft USPSTF recommendations are adopted in their current form, the effect will be to limit women’s access to life-saving technology, reverse the decline in breast cancer morbidity and mortality, and cause undue suffering to women and their families facing breast cancer. The ACR has asked the task force to follow sound scientific reasoning and protect women’s access to this vital screening tool.
By Chris Hobson, Imaging 3.0™ senior communications manager