WASHINGTON -- November 20, 2009 -- The announcement this week from a federal scientific panel that women aged 40-49 should not get routine annual mammograms emphasizes the need to improve the way scientific evidence is weighed and recommendations are determined.
The U.S. Preventive Services Task Force announced Monday that it is recommending against routine mammograms for women aged 40-49 and that there is not enough evidence to make a mammography recommendation for women aged 75 and older. The American Cancer Society, which also publishes guidelines for cancer screenings, continues to recommend annual screening using mammography and clinical breast examination for all women beginning at age 40.
The American Cancer Society Cancer Action Network (ACS CAN), the Society's advocacy affiliate, for months has been urging lawmakers to include language in health care reform legislation that supports a transparent, inclusive and evidence-based process for making recommendations about preventive services.
"The cancer community has long been concerned that the task force makes recommendations largely out of the public eye and with little or no input from the broader patient or scientific community," said John R. Seffrin, chief executive officer of ACS CAN. "Lawmakers should look at the task force’s announcement as an opportunity to make needed changes that bolster public confidence in the task force’s work."
USPSTF recommendations could have elevated significance in health care reform legislation -- current proposals require prevention measures with an 'A' or 'B' rating from the task force to be included in any essential benefits package. ACS CAN is working with lawmakers to ensure that legislation guarantees access to proven preventive services, including mammography for all women aged 40 and over. ACS CAN also is advocating that an essential benefits package cover more than what receives a task force grade of 'A' or 'B', and that USPSTF recommendations constitute a floor, not a ceiling, for coverage.
ACS CAN has proposed the following changes to the function and composition of the task force:
* Membership -- USPSTF membership should include experts in clinical and community medicine, health delivery, public health, and health data, as well as patient representation and representatives experienced in minority health and health disparities.
* Transparency -- USPSTF meetings should be open to the public, and the methodologies used to establish priorities should be made available to the public through forums and drafts that are subject to public review and comment before being made final.
* Representation -- USPSTF advisory panels should include a cross-section of interests, including patient representatives, experts in health care delivery and health care providers.
* Outside sources -- The Secretary of Health and Human Services should be empowered to recognize other sources and interpretations of scientific evidence in determining recommendations for preventive services.
"We encourage lawmakers to add a provision to health care reform legislation that would open the process for making these recommendations and incorporate the perspectives and interpretations of outside individuals and groups," said Daniel E. Smith, president of ACS CAN. "Constructive changes will lead to a more transparent and inclusive process for the task force to perform its important work."
ACS CAN has long advocated for legislation at the state level that guarantees coverage of proven preventive services in accordance with Society guidelines. Currently, private insurers in 49 states (Utah excluded) are required to cover routine mammography. In all 50 states, Medicaid and Medicare provide coverage for breast cancer screenings for women over 40.
ACS CAN, the nonprofit, nonpartisan advocacy affiliate of the American Cancer Society, supports evidence-based policy and legislative solutions designed to eliminate cancer as a major health problem. ACS CAN works to encourage elected officials and candidates to make cancer a top national priority. ACS CAN gives ordinary people extraordinary power to fight cancer with the training and tools they need to make their voices heard. For more information, visit www.fightcancer.org.