In a perplexing move, earlier this week the United States Preventive Services Task Force (USPSTF or Task Force) finalized its draft breast cancer screening recommendations – despite recently passed legislation that prevents their implementation. As the head of American Women Unite for Breast Cancer Screening and a doctor who diagnoses breast cancer daily, I’m dumbfounded and disappointed.
It is worth noting that the Task Force does not include anyone who is an expert in radiology, breast cancer or who provides care for breast cancer patients. Also, the majority of studies reviewed by the Task Force in order to assess mammograms as a screening tool were conducted in Sweden and Canada and as far back as 25 years ago. In fact, the largest and longest running breast cancer screening studies in history reconfirm that regular screening cuts breast cancer deaths by roughly a third in all women over age 40 — including those aged 40 to 49.
The USPSTF also focused extensively on its interpretation of harms vs. benefits. Overdiagnosis of breast cancer was one such harm. What the Task Force fails to note is that scientific evidence shows there is little if any overdiagnosis of breast cancer using mammography. I would argue we should be far more concerned with underdiagnosis of a disease that claims the lives of an estimated 40,000 women each year.
The Task Force recommendations create further confusion among women, who remain unsure when to get screened. Physicians as well must weigh conflicting information as they seek to guide their patients. The good news is that many of the nation’s leading medical organizations support screening at age 40. Many of these organizations are made up of physicians who treat or diagnosis breast cancer on a daily basis. The American Congress of Obstetricians and Gynecologists, American College of Radiology, Society of Breast Imaging, National Comprehensive Cancer Network, and the American Medical Association recommend screening at 40 – while the USPSTF is the outlier at 50.
Luckily, Congress stepped in and passed legislation that places a two-year moratorium on the implementation of the Task Force’s recommendations, allowing time for the medical community to come together and begin a more inclusive and thorough discussion about the clinical value of early detection. Despite what some have said, Congress did not ask the Task Force to change recommendations or intervene on clinical issues, but simply to listen to and consider additional voices before finalizing.
The USPSTF’s statements this week seem to stress that women and their doctors can still decide to chose a mammogram starting at 40, but it is a very disingenuous claim when their own recommendations would lesson the likelihood of insurance coverage and certainly result in a co-pay – thankfully Congress passed a two-year timeout. Without that legislative action, women ages 40 to 49 would have been at risk for losing insurance coverage (co-payment, co-insurance or deductible) for their annual mammograms. The USPSTF’s decision to finalize its guidelines anyway means that, unfortunately, many women will hear the news and delay their mammogram until age 50. This will let cancers go undetected, leading to later-stage diagnosis and costlier treatments down the road.
As a doctor on the front lines, I can tell you that early detection remains our best defense against this deadly disease. We know that women who develop breast cancer between the ages of 40 and 49 often develop more aggressive types of cancer with a worse prognosis. Black women in particular tend to be diagnosed with these types of cancer, and are more likely to die from them than white women. And among Hispanic/Latina women, breast cancer is the leading cause of cancer death.
Given all of the data showing that routine screening beginning at age 40 save the most lives, I cannot understand why the USPSTF would deny women a fighting chance.
Dr. Michelle L. Rivera is the head of American Women Unite for Breast Cancer Screening and a board-certified radiologist and fellowship trained breast imager who cares for women with breast cancer daily