Feature | April 20, 2015

ACR and SBI Release Statement on USPSTF Breast Cancer Screening Recommendations

Both organizations say the recommendations would cost thousands of lives and could eliminate mammography insurance coverage for millions of women

ACR, SBI, USPSTF, breast cancer screening recommendations, coverage

April 20, 2015 — The American College of Radiology (ACR) and Society of Breast Imaging (SBI) have issued a statement saying that adoption of draft United States Preventive Services Task Force (USPSTF) breast cancer screening recommendations would result in thousands of additional and unnecessary breast cancer deaths each year. Thousands more women would experience more extensive and expensive treatments than if their cancers were found early by a regular mammogram. Adoption of these USPSTF recommendations could also strip millions of women 40-and-older of private insurance coverage with no copay for mammograms at the time of their choosing previously guaranteed by the Affordable Care Act (ACA).

The ACA requires private insurers to cover exams or procedures given a grade of “B” or higher by the USPSTF. The Task Force gave routine screening of women ages 40-49 a grade of “C” and gave a “B” grade only to biennial (every other year) screening for women 50-74. This would indicate that women ages 40-49 who choose routine screening and those 50-74 who want to be screened annually would not be guaranteed coverage. This may particularly impact underserved and rural areas.

“We believe that the Secretary of the U.S. Department of Health and Human Services (HHS) can clarify now whether adoption of these USPSTF recommendations would mean that private insurers no longer have to cover mammograms for millions of women 40-49 who, together with their doctor, choose to have regular mammograms and those 50-74 who choose to be screened annually. We call on her to affirm that coverage will not be affected,” said Bibb Allen, M.D., FACR, chair of the American College of Radiology Board of Chancellors.

According to National Cancer Institute data, since mammography screening became widespread in the mid-1980s, the U.S. breast cancer death rate has dropped 35 percent. Insurance coverage has enabled this dramatic reduction in breast cancer deaths. Published analysis, using the task force’s 2009 methodology, showed that if women ages 40-49 go unscreened, and those 50-74 are screened biennially, approximately 6,500 additional women each year in the United States would die from breast cancer.

A 2014 study published in the JAMA Internal Medicine shows that patients experience short-term anxiety regarding test results that rapidly declines over time with no measurable effect to women’s health from a false-positive exam. Past research indicates that nearly all women who experience a false-positive exam support screening and want to know their status. The USPSTF made a value judgement – not a scientific judgement – that, based on the link between USPSTF recommendations and insurance coverage, effectively takes away women’s right to choose when or if to be screened for the nation’s second leading cause of cancer death in women. 

“The USPSTF limited its consideration to studies that underestimate the lifesaving benefit of regular screening and greatly inflate overdiagnosis claims. They ignored more modern studies that have shown much greater benefit. These limitations result in the misrepresentation of the real trade-offs that women and healthcare providers need to know about in order to make good decisions about screening. They also ignored the demonstrated views of American women on screening. Unfortunately, these recommendations will only add to confusion that is placing women at risk,” said Barbara Monsees, M.D., FACR, chair of the American College of Radiology Breast Imaging Commission.

The USPSTF does not comply with Institute of Medicine (IOM) recommendations for guideline development – widely regarded as the medical standard. The methods used by the USPSTF do not meet the IOM thresholds to be considered "trustworthy guidelines". No breast cancer experts sit on the task force that created these recommendations. The USPSTF did not allow participation of breast cancer or breast screening experts at meetings where evidence was reviewed. The lack of transparency does not meet the IOM standard. These recommendations should be regarded as suspect until experts recognized by major organizations in this area of medicine are included in a meaningful way in their creation.

“These USPSTF draft recommendations are based on a curiously selective analysis that does not foster a great deal of trust. Their recommendation creation process does not comply with IOM standards for trustworthy guideline creation that most major medical organizations are working to meet. This lack of transparency, lack of breast cancer expertise, and exclusion of studies that would support screening effectiveness and lower overdiagnosis estimates may result in unnecessary lives lost,” said Murray Rebner, M.D., FSBI, president of the Society of Breast Imaging.

The ACR and SBI back the USPSTF Transparency and Accountability Act of 2015 (H.R. 1151), recently introduced in the House of Representatives by Reps. Marsha Blackburn (R-TN) and Bobby L. Rush (D-IL).

The bill seeks greater USPSTF transparency regarding the public comment process, adherence to the Administrative Procedure Act, engaging stakeholder experts and patients in a meaningful way and public access to deliberations and supporting materials. 

For more information: www.acr.org, www.sbi-online.org

Related Content

Partial Breast Irradiation Effective, Convenient Treatment Option for Low-Risk Breast Cancer
News | Radiation Therapy | May 20, 2019
Partial breast irradiation produces similar long-term survival rates and risk for recurrence compared with whole breast...
Managing Architectural Distortion on Mammography Based on MR Enhancement
News | Mammography | May 15, 2019
High negative predictive values (NPV) in mammography architectural distortion (AD) without ultrasonographic (US)...
Screening MRI Detects BI-RADS 3 Breast Cancer in High-risk Patients
News | MRI Breast | May 09, 2019
When appropriate, short-interval follow-up magnetic resonance imaging (MRI) can be used to identify early-stage breast...
Novel Artificial Intelligence Method Predicts Future Risk of Breast Cancer
News | Artificial Intelligence | May 08, 2019
Researchers from two major institutions have developed a new tool with advanced artificial intelligence (AI) methods to...
Georgia Becomes 38th State With Breast Density Inform Law
News | Breast Density | May 06, 2019
Georgia Gov. Brian Kemp signed breast density inform bill HB62 into law May 3, 2019. The law, which becomes effective...
American Society of Breast Surgeons Issues Risk-based Screening Mammography Guidelines
News | Mammography | May 03, 2019
The American Society of Breast Surgeons (ASBrS) has released the first screening mammography guidelines based on a...
Hologic Launches Trident HD Specimen Radiography System
Technology | Breast Biopsy Systems | April 26, 2019
Hologic Inc. announced global commercial availability of the Trident HD specimen radiography system. The next-...
California Protons Cancer Therapy Center Begins Breast Cancer Study Enrollment
News | Proton Therapy | April 25, 2019
California Protons Cancer Therapy Center announced two major efforts representing significant steps forward in breast...
Women With Coronary Artery Wall Thickness at Risk for Heart Disease
News | Cardiac Imaging | April 25, 2019
The thickness of the coronary artery wall as measured by magnetic resonance imaging (MRI) is an independent marker for...
The Cianna Medical Savi Scout Radar Localization system, showing the console, detector and the marker, with a size comparison and X-ray images inside breast tissue. For more information on the learning curve of its use http://sabcs16.posterview.com/nosl/p/P1-11-06.

The Cianna Medical Savi Scout Radar Localization system, showing the console, detector and the marker, with a size comparison and X-ray images inside breast tissue. For more information on the learning curve of its use http://sabcs16.posterview.com/nosl/p/P1-11-06.

Feature | Breast Imaging | April 24, 2019 | By Greg Freiherr
Wires have traditionally been placed prior to lumpectomy to mark cancerous tissues in the breast.