(Bloomberg) — A decision from a panel of U.S. doctors and health experts threatens to reignite the debate over how much breast cancer screening is appropriate, potentially opening the door for insurers to stop covering some mammograms.
In a draft proposal, the U.S. Preventive Services Task Force (USPSTF) said Monday that most women under 50 may not need regular mammograms to look for breast cancer. The Patient Protection and Affordable Care Act (PPACA) generally lets insurers limit coverage for screenings that the panel doesn't back. The law currently requires them to adhere to guidelines calling for women ages 40 and older to have mammograms every one to two years.
The panel is attempting to weigh the benefits and harms of screening for breast cancer. Because the disease becomes more common as women get older, the screening is most helpful for those over 50, the panel said.
Younger women are significantly more likely to experience a false positive result and undergo additional procedures including biopsies to rule out a cancer that isn't present, said Michael LeFevre, the task force's past chairman. Others get treatment for conditions that would never harm them. The data show that mammograms would prevent 4 deaths for every 10,000 women ages 40 to 49 who undergo screening for a decade.
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"This is the best balance of benefits and harms," said LeFevre, a professor at the University of Missouri School of Medicine. "Breast cancer is an uncommon disease for women in their 40s." The independent panel weighs medical evidence only, not costs.
Unnecessary treatment
False positives, where women undergo additional procedures to rule out a suspicious finding on mammography, occur in 1,212 of every 10,000 women age 40 to 49, according to a report by the panel. About one in five women diagnosed based on mammography get treatment for a cancer that otherwise would have gone undetected or never caused health problems, according to the report.
The proposal is open for public comment through May 18, after which the task force will make a final recommendation.
"Because USPSTF recommendations are often used by insurance companies and government programs to determine coverage, we are concerned that women and their health care providers will be deterred from screening that might be appropriate," said Judith Salerno, president of the Susan G. Komen breast cancer foundation. "Worse yet, the recommendations may cause women under 50 to delay paying attention to their breast health and breast cancer risk."
Benefits and Risks
The new guidelines overstate the harms of screening and understate the benefits, said Barbara Monsees, chairwoman of the American College of Radiology's Breast Imaging Commission. She said the guidelines could reduce coverage for the screening and discourage doctors from recommending mammograms.
Because the guidelines could affect insurance coverage, women who don't have the means to afford mammograms will be particularly affected, Monsees said.
