Cost of USPSTF draft guidelines: 17 million women lose mammography coverage

How many women will lose coverage of breast cancer screening if the draft breast screening recommendations announced by the United States Preventive Services Task Force (USPSTF) in April are implemented? Approximately 17 million women ages 40 to 49 would lose guaranteed coverage of mammography, according to recent analysis by Avalere.

Sung Hee Choe, director at Avalere, said it’s important to pay close attention as these draft recommendations get finalized.

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

The draft recommendations have gained a lot of attention by giving mammograms for women ages 40 to 49 and annual mammograms for women ages 50 to 74 a “C” grade, which means those mammograms would not be be automatically covered by the ACA. The ACA says that providers must cover any tests that receive a “B” grade or higher from the USPSTF.

The USPSTF listed such “potential harms” as overdiagnosis, false-positive results and false reassurance from false-negative tests as reasoning for its decision.

Avalere reached the figure of 17 million by looking at demographics of various insurance markets and determining the number of women ages 40 to 49 who would be affected by the recommendations.

As Avalere points out in its report, the USPSTF released the same recommendation in November 2009, but when the ACA was passed in 2010, wording was included that said screening guidelines that are “the most current other than those issued in or around November 2009” would be followed. Updated recommendations would of course put an end to that stipulation’s ability to keep coverage guaranteed for women ages 40 to 49 years.

The ACR, SBI and Senator Barbara Mikulski, D-MD, all spoke out against the USPSTF’s draft recommendations when they were first announced.

The ACR and SBI released a joint statement at the time, warning that following the recommendations “would result in thousands of additional and unnecessary breast cancer deaths each year.” Mikulski sent a letter to HHS Secretary Sylvia Mathews Burwell, writing that following the draft recommendation could “erode the mammogram benefit in current law.”

“I think this recommendation is short-sighted and could potentially put women’s lives at risk,” Mikulski said in her letter. “Failing to identify women in their 40s with breast cancer and instead having them wait until age 50 to get a mammogram is not only a disservice, it is a travesty.”