17M women may lose mammography screening coverage under USPSTF recommendations

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 - Breast screening

An analysis by Alavere Health estimates that new recommendations from the U.S. Preventative Services Task Force (USPSTF) could cause 17 million women to lose guaranteed coverage of preventive breast cancer screenings.

The report comes on the heels of  last month’s draft update from USPSTF that gave a “C” rating to annual mammography screenings for women aged 40-49, a rating that would cause coverage for such screenings to be lost under the Affordable Care Act. In the update, the USPSTF cited the possibilities of overdiagnosis, unnecessary biopsies and high numbers of false positive tests as the main reasons for recommending coverage for biennial screenings beginning at age 50 as opposed to age 40. Expanding screening would only save one additional life per 1,000 screenings at the cost of many more false positives and potential unnecessary treatments, according to the USPSTF.

“USPSTF’s final recommendation will determine how breast cancer screenings are covered for millions of women,” said Avalere director Sung Hee Choe. “Policymakers and women’s health groups need to take a close look at the implications of the draft guidelines.”

The estimate comes from an analysis of results from the 2014 American Community Survey regarding health insurance and demographics, which were used to determine the number of women impacted by USPSTF’s decision.

The public comment period has now closed regarding the recommendations, but critics within both politics and medicine have spoken out against the proposed screening guidelines. More than 60 members of congress—including two breast cancer survivors—have signed a letter urging President Obama to disregard the recommendations from the USPSTF, and  many in the imaging community, including the American College of Radiology, have taken a similarly strong stance against the USPSTF screening recommendations.

“The USPSTF limited its consideration to studies that underestimate the lifesaving benefit of regular screening and greatly inflate overdiagnosis claims,” said Barbara Monsees, MD, FACR, chair of the ACR Breast Imaging Commission, in a statement. “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 health care 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.”