by
Lisa Chamoff, Contributing Reporter | July 15, 2015
From the July 2015 issue of HealthCare Business News magazine
In 2009 there was a huge outcry after the U.S. Preventive Services Task Force (USPSTF) released its breast cancer screening recommendations, which stated that women between the ages of 50 and 74 should receive screening with mammography every two years, while women in their 40s should discuss the benefits of regular screening with their physicians.
In April, the criticism was renewed when the USPSTF came to largely the same conclusion, giving biennial screening of women ages 50 to 74 a “B” recommendation, while screening for women in their 40s was given a “C” recommendation, with the caveat that screening in this age group may benefit few women and could even cause them harm, leading to more false positives and unnecessary biopsies.
A “B” recommendation from the USPSTF means the task force believes there is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial, while the “C” recommendation means that the USPSTF recommends “selectively offering or providing this service to individual patients based on professional judgment and patient preferences” and that, “there is at least moderate certainty that the net benefit is small.”
The USPSTF did not provide an “A” recommendation for mammography. In some ways, the landscape in the breast imaging field is the same as it was six years ago, but in many ways it’s very different. The recommendations come as technology to measure breast density, along with newer modalities — including tomosynthesis (which is delved into separately in this issue), automated whole breast ultrasound, molecular imaging, and MR — that go beyond the gold standard of mammography, have advanced. Clinicians, while anticipating nasty fallout from the recommendations, are also utilizing this new technology and launching programs to help better inform women of their options.
Giving the recommendations an ‘F’
Many radiologists are worried that with the institution of the Affordable Care Act, which only requires private insurers to cover procedures with a “B” recommendation or higher from the USPSTF, many fast growing cancers in younger women will go undetected. If the USPSTF’s screening guidelines are finalized, 17 million women between the ages of 40 and 49 could lose insurance coverage for mammography, according to a report released in May by consulting firm Avalere Health.
“I’m not opposed to people making their own decisions for screening,” says Dr. Linda Greer, a radiologist and medical director of the HonorHealth Breast Health and Research Center in Arizona. “But you know a huge chunk of the population will say, ‘I can’t afford that.’ It’s scary to think that a lot of women will opt to not [get screened] because of the coverage.”
