Ikonopedia News and Events


Mammography Experts Tell Capitol Hill to "Stop the Confusion"


Advocacy in Action eNews/ In the June 19, 2015 Issue

Rep. Debbie Wasserman Schultz (D-FL) credits a mammogram for increasing her breast health awareness. That awareness prompted her to perform a routine self-exam, which saved her life, she said, during a Capitol Hill briefing hosted by the Congressional Families Cancer Prevention Program of the Prevent Cancer Foundation and the Society of Breast Imaging (SBI) on June 17.

She discovered a lump in 2007 while checking for calcium deposits, which she had just learned she was at risk of for. She was 41 years old. Unknown to her at the time, she also was at high genetic risk for developing breast cancer. Her breast cancer diagnosis – one given to nearly 65,000 women under age 50 each year in the United States – required multiple surgeries and a double mastectomy to treat. Now a cancer survivor of eight years, Wasserman Schultz joined leaders in radiology, surgery and oncology at the briefing, where she condemned recent United States Preventive Services Task Force (USPSTF) draft mammography guidelines. Those guidelines conclude that the harms of potentially unnecessary procedures, such as a biopsy and anxiety associated with false positives outweigh the life-saving benefits of screening.

According to the American College of Radiology (ACR) and the SBI, the implications of these guidelines could severely restrict access to mammography screening for women aged 40-49. Many would no longer be able to afford screening because their private insurance coverage would likely be dropped.

The Affordable Care Act mandates that insurance plans cover exams and procedures rated “B” or higher by the USPSTF. The new guidelines grade routine mammography for women aged 40-49 a “C.” Also, women 50-74 who want to be screened annually might be denied yearly coverage since the USPSTF guidelines gave a “B” rating for screening in this age group only every other year.

“As members of Congress concerned about the impact of breast cancer, we believe, and many experts agree, that delayed detection and treatment have a far worse outcome than the harms the USPSTF has laid out,” Wasserman Schultz said. “Early detection saves lives; I’m living proof, and that is a risk worth taking.”

The briefing, titled “Breast Cancer Screening: Ending the Confusion,” also featured a discussion led by Lisa McGovern, Executive Director of the Congressional Families Cancer Prevention Program. ACR members, Dr. Elizabeth Morris, SBI President and Chief of Breast Imaging Service at Memorial Sloan Kettering Cancer Center, and Dr. Murray Rebner, SBI Immediate Past President and Professor of Diagnostic Radiology and Molecular Imaging at Oakland University William Beaumont School of Medicine, also presented. Dr. Regina Hampton, Medical Director and Co-Founder of Breast Care for Washington added the breast surgeon’s perspective. Rebner questioned the task force’s expertise on the subject as well as their transparency regarding their methodology in forming their recommendations. He also took issue with the task force’s priority to spare women of the harms of mammography, despite the task force’s own admission that screening over the age of 40 reduces breast cancer deaths by 18 percent.

“Basically the task force made a value judgement. They said, in their opinion, they are trying to maximize the number of lives saved per mammogram,” Rebner said. “What they should be doing is saying, ‘how many lives can we save, period?’”

“The bottom line is, we strongly believe that these recommendations should not be implemented and followed,”
he said.

Morris, who called for a moratorium on the recommendations, called them “tragic,” noting that the data the task force used was old, discounted and did not account for technological advances, such as 3D mammography, which improves detection rates and decreases harms.

“We have progressed; the USPSTF has not; it’s stuck in the past,” Morris said.

Hampton, the only dedicated female breast surgeon in Prince George’s County, MD, provided a practitioner’s view, noting the disparities in the African American communities where people may be less likely to get screened for breast cancer and may die at a higher rate and at earlier ages.

“They really have not taken the entire population into consideration,” Hampton said of the USPSTF. “Within the last couple of weeks I’ve diagnosed a 38-year-old, a 32-year-old and a 39-year-old with breast cancer. Do you think they are going to be around at age 50 to get that first screening mammogram? They may not be. I think it’s just tragic we’re trying to put everyone in a box.”

ACR members Elizabeth Morris, MD, and Murray Rebner, MD, breast surgeon Regina Hampton,MD, and Rep. Debbie Wasserman Schultz (D-FL) at Capitol Hill mammography briefing.