The AAFP has signed on to a letter (3-page PDF; About PDFs) to members of Congress that aims to set the record straight about recently revised breast cancer screening recommendations from the U.S. Preventive Services Task Force, or USPSTF.
AAFP, Other Groups Seek to 'Set the Record Straight' on USPSTF Recs
Letter Clarifies Breast Cancer Screening Recommendations
By News Staff
On Dec. 2, the House Committee on Energy and Commerce's Subcommittee on Health and Environment met to examine the USPSTF recommendations, which have been the subject of much debate since they were published Nov. 17 in the Annals of Internal Medicine.
The letter, which was signed by 10 other national health care organizations, was sent to several congressional leaders, including Rep. Henry Waxman, D-Calif., chairman of the House Energy and Commerce Committee, and Rep. Joe Barton, R-Texas, the ranking member of that committee.
The AAFP is in the process of reviewing the breast cancer screening recommendations from the USPSTF, but it joined in defending the task force, which has been the target of harsh criticism in recent weeks.
The letter highlights three common inaccuracies that have appeared in media reports:
The letter, which was signed by 10 other national health care organizations, was sent to several congressional leaders, including Rep. Henry Waxman, D-Calif., chairman of the House Energy and Commerce Committee, and Rep. Joe Barton, R-Texas, the ranking member of that committee.
The AAFP is in the process of reviewing the breast cancer screening recommendations from the USPSTF, but it joined in defending the task force, which has been the target of harsh criticism in recent weeks.
The letter highlights three common inaccuracies that have appeared in media reports:
- the task force recommends that women ages 40-49 not receive mammograms;
- the task force recommendations were intended to reduce costs by reducing the number of mammograms women receive; and
- members of the task force are not qualified to make scientific recommendations, or have agendas that influence their recommendations.
The letter then addresses each of these false statements.
In its revised recommendations, says the letter, the USPSTF recommended against routine screening mammography for women ages 40-49 who aren't at increased risk for breast cancer because the benefit-risk calculation for women in that age group is much less clear than it is for older women.
"Women in their (40s) with no identifiable risk factors are much less likely to have breast cancer than those aged 50 and above with no risk factors," the letter says. "Moreover, mammograms in this age group have a much higher likelihood of generating false positives than (those) in older women."
False-positive results, the letter continues, can lead to harms such as additional X-rays, unnecessary biopsies, and other invasive procedures and treatments, as well as significant anxiety among women and their families.
Rather than recommend that all women in this age group receive routine mammograms starting at age 40, the USPSTF recommends that these patients and their physicians discuss the risks and benefits of screening, as well as information about the patient's family history, overall health and personal preferences.
"The result is an empowered patient who is able to make an informed decision about whether or not to be tested," says the letter.
The letter also notes that the USPSTF never uses cost as a reason to recommend against a service that has been proven to be effective.
"For each preventive service it reviews, the task force assesses the quality of the scientific information, estimates the magnitude of benefits and harms, reaches consensus about each service's net benefit, and issues a recommendation," the letter says.
Finally, the letter addresses the issue of USPSTF member qualifications, pointing out that the task force "has been recognized as the authoritative source for determining the effectiveness of clinical preventive services" since its inception in 1984. The task force comprises primarily clinicians -- doctors, nurse practitioners and nurses -- as well as experts in prevention research.
Four of the USPSTF's 16 members also are AAFP members. They are
In its revised recommendations, says the letter, the USPSTF recommended against routine screening mammography for women ages 40-49 who aren't at increased risk for breast cancer because the benefit-risk calculation for women in that age group is much less clear than it is for older women.
"Women in their (40s) with no identifiable risk factors are much less likely to have breast cancer than those aged 50 and above with no risk factors," the letter says. "Moreover, mammograms in this age group have a much higher likelihood of generating false positives than (those) in older women."
False-positive results, the letter continues, can lead to harms such as additional X-rays, unnecessary biopsies, and other invasive procedures and treatments, as well as significant anxiety among women and their families.
Rather than recommend that all women in this age group receive routine mammograms starting at age 40, the USPSTF recommends that these patients and their physicians discuss the risks and benefits of screening, as well as information about the patient's family history, overall health and personal preferences.
"The result is an empowered patient who is able to make an informed decision about whether or not to be tested," says the letter.
The letter also notes that the USPSTF never uses cost as a reason to recommend against a service that has been proven to be effective.
"For each preventive service it reviews, the task force assesses the quality of the scientific information, estimates the magnitude of benefits and harms, reaches consensus about each service's net benefit, and issues a recommendation," the letter says.
Finally, the letter addresses the issue of USPSTF member qualifications, pointing out that the task force "has been recognized as the authoritative source for determining the effectiveness of clinical preventive services" since its inception in 1984. The task force comprises primarily clinicians -- doctors, nurse practitioners and nurses -- as well as experts in prevention research.
Four of the USPSTF's 16 members also are AAFP members. They are
- task force chair Ned Calonge, M.D., M.P.H., chief medical officer of the Colorado Department of Public Health and Environment and associate professor of family medicine and of preventive medicine and biometrics at the University of Colorado Health Sciences Center, Denver;
- Allen Dietrich, M.D., professor in the department of community and family medicine at Dartmouth Medical School, Hanover, N.H., and associate director for population sciences at the Norris Cotton Cancer Center at Dartmouth-Hitchcock Medical Center;
- Michael LeFevre, M.D., M.S.P.H., professor, associate chair and director of clinical services in the department of family and community medicine at the University of Missouri, Columbia; and
- Joy Melnikow, M.D., M.P.H., professor in the department of family and community medicine and associate director of the Center for Healthcare Policy and Research at the University of California, Davis.
Related ANN Coverage
USPSTF Chair Defends Task Force, Breast Cancer Screening Recommendations
Leader Acknowledges Recs Were Poorly Worded
(12/2/2009)
USPSTF Makes Sweeping Changes to Breast Cancer Screening Recommendations
Task Force No Longer Recommends Routine Mammograms in Women Ages 40-49
(11/18/2009)
Additional Resource
U. S. Preventive Services Task Force: Screening for Breast Cancer
USPSTF Chair Defends Task Force, Breast Cancer Screening Recommendations
Leader Acknowledges Recs Were Poorly Worded
(12/2/2009)
USPSTF Makes Sweeping Changes to Breast Cancer Screening Recommendations
Task Force No Longer Recommends Routine Mammograms in Women Ages 40-49
(11/18/2009)
Additional Resource
U. S. Preventive Services Task Force: Screening for Breast Cancer
