Proposed changes to breast cancer screening criticized

The Editor-in-Chief of Cancer Investigation and one of the country's most respected medical policy professors has written a new commentary which criticizes proposed changes to breast cancer screening. The federally-funded US Preventive Services Task Force (USPSTF) has recommended an about-turn in breast cancer screening, which includes recommending against routine screening in the 40-49 year old range, screening only every other year in older women and explicitly recommending against teaching women breast self-examination (BSE).

"In the current healthcare reform debate in the United States, few issues have generated more opinions and greater confusion than the value of cancer screening," says Dr Gary H Lyman, Editor-in-Chief of Cancer Investigation and Professor of Medicine and Director of Comparative Effectiveness and Outcomes Research at Duke University and Senior Fellow at the Duke Center for Clinical Health Policy Research.

"When a government-commissioned panel makes major changes in medical recommendations that have been in place for many years and are still held by most other professional organizations without any substantial change in the available evidence, it is essential that they be aware of the enormous adverse impact that these changes may have on patients, their physicians and on the broader issues at stake in healthcare reform."

The new USPSTF guidelines fly in the face of those from the American College of Physicians, the National Comprehensive Cancer Network, the American Medical Association, the American Academy of Family Physicians, the American College of Obstetrics and Gynecology and the Canadian Task Force on Preventative Health Care and, until recently, their own organization.

Routine screening also saves thousands of lives and experts say that even a small increase in the occurrence of more advanced disease resulting from less frequent screening may have a long term adverse impact not only on women's lives, but also on overall healthcare costs. In addition, modeling studies show that maximum life years for patients are achieved by initiating screening at age 40 years.

"There is an immediate and compelling need for major healthcare reform in the USA and we can no longer afford to stand still and waste limited resources for ineffective interventions while millions of Americans go without access to proven effective screening and treatment," concedes Dr Lyman. "However, available, effective and safe measures such as breast cancer screening should not become the focus of this debate.

Efforts to improve the survival and quality of life for women with breast cancer require the rational application of any and all proven effective strategies including screening, mammograms and BSEs. While Lyman agrees that more research is needed, he warns that the suggested changes in screening are likely to lead to greater confusion and a reduction of breast screening efforts, which may cost patient lives.

In addition, Dr Lyman points out two real and opposing dangers that may emerge from the controversy around the new USPSTF recommendations for breast cancer screening.

"First, the Center for Medicare and Medicaid Services or private insurers could act on the suggestions of the federally-funded USPSTF and reverse their policy of reimbursement for breast cancer screening, adding further to the barriers women already face to appropriate breast cancer screening.

"Secondly, and perhaps of even greater concern, is the potential for the confusion and anger surrounding the new recommendations being labeled by opponents of healthcare reform as an example of rationing and what will happen when the government takes over healthcare in the US.

"We cannot allow this debate over breast cancer screening to strengthen opposition to the best opportunity to date for meaningful and long overdue healthcare reform that will provide access to important healthcare advances to all Americans," says Dr Lyman.