From the July 2015 issue of HealthCare Business News magazine


Greer, who started practicing in 1996, says she has seen an increase in women under 50 being diagnosed with breast cancer. She notes that a very small percentage of women have a BRCA mutation and the vast majority have no known family history. “To sit there and say we’ll screen the high-risk patients, you’re going to miss a huge chunk,” Greer says. “Sixty percent have zero known risk factors. Then you’re going to miss 60 percent because we don’t know enough.”

Dr. Raymond Tu, chairman of radiology at United Medical Center (UMC)/Not-For-Profit Hospital Corporation (NFPHC) in Washington, DC, says this is a big issue for low-income populations. “The decision by the task force had many variables,” Tu says. “A lot of that was economic, and the expansion of patients eligible for insurance coverage. We have patients who are the most vulnerable in the health system able to get health care. We have decreased the amount of access for mammograms. It’s almost like giving someone a benefit and indirectly taking that away.”


Dr. Kirsten Bibbins-Domingo, an internist at San Francisco General Hospital and a member of the USPSTF, says that the group’s 2009 recommendation, particularly its “C” recommendation for women in their 40s, was “widely misunderstood.” “Since 2009, the Task Force has taken steps to clarify what a ‘C’ recommendation is – it is not a recommendation against screening,” Bibbins-Domingo says. “Rather, it means that, for this age group, screening may benefit a few women, while others may experience significant harms. Also, much has been written about the balance of benefits and harms of mammography in the past five years that relates to our recommendation, specifically that people know it is a good test but not a perfect test.”

Bibbins-Domingo says the group’s recommendations will remain in draft form, which does not affect coverage requirements, while the task force deliberates on their final recommendation. “Insurance companies may, and do cover many services that receive other grades, such as a ‘C,’ ” Bibbins-Domingo says. In a group op-ed published in the Arizona Republic in May, Greer, along with Dr. Lise Walker, an Arizona breast surgeon, and Dr. Coral Quiet, a radiation oncologist, wrote that they were “deeply concerned” that the task force said it did not find enough evidence to determine whether 3D mammography provides better overall health outcomes for women.

“The task force recommendations are based on outcomes from outmoded film and digital systems,” they wrote. “That means its conclusions are as outmoded as the technologies on which they were based.” Bibbins-Domingo says the task force used all available evidence, such as models, on current breast cancer screening modalities, including 3D mammography, MRI, and ultrasound. The scientific evidence review included more recent observational evidence about the efficacy of mammography, and the modeling data also looked at digital mammography.

July 2015 Magazine

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