USPSTF Chair Defends Task Force, Breast Cancer Screening Recommendations

Family physician Ned Calonge, M.D., M.P.H., chairman of the U.S. Preventive Services Task Force, or USPSTF, defended the task force and its recently revised breast cancer screening recommendations before a House subcommittee on Dec. 2. In his testimony, however, he acknowledged that portions of the controversial recommendations were poorly phrased.

In written testimony (14-page PDF; About PDFs) he submitted to the Health Subcommittee of the House Energy and Commerce Committee in conjunction with USPSTF Vice Chair Diana Petitti, M.D., M.P.H., Calonge said that the mammography recommendations the USPSTF made pertaining to women ages 40-49 "did not say what the task force meant to say."

He also said the task force is committed to changing the way it communicates to ensure that "this kind of miscommunication does not occur in the future."

In its updated recommendations released Nov. 17, the USPSTF recommended a shift from annual to biennial screening mammography in women ages 50-74 and recommended against routine screening mammography for women ages 40-49 who aren't at increased risk for breast cancer.

Calonge, who also is 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 in Denver, stood by the new recommendations, but he clarified the USPSTF's stance on mammography for women ages 40-49.

"Screening starting at age 40 should not be automatic," he said in his testimony. "Nor should it be denied. What we are saying is that the decision to have a mammogram for women in their 40s should be based on a discussion between a women and her doctor. Many doctors and many women, perhaps even most women, will decide to have mammography screening starting at age 40. The task force supports those decisions."

Calonge also defended the USPSTF, which faced harsh criticism after release of the recommendations last month. He said the task force voted on the recommendations in June 2008 -- well before the 2008 presidential election and the ensuing national health reform debate. However, he added, the release date of the recommendations was determined by the Annals of Internal Medicine's publication schedule.

"We are well familiar with the ruthless horror of cancer, and the role that detection and treatment plays," Calonge testified. "We certainly know that mammography saves lives. However, our job as the task force is to rigorously review scientific evidence. Politics play no part in our processes. Cost and cost-effectiveness were never considered in our discussions."

The AAFP was one of 11 health care organizations that signed on to a letter (3-page PDF; About PDFs) defending the USPSTF prior to the subcommittee hearing. The Academy also is in the process of reviewing the task force's breast cancer screening recommendations.