USPSTF publishes final breast cancer screening recommendations, organizations react

The U.S. Preventive Services Task Force (USPSTF) published its final breast cancer screening recommendations this week, officially giving biennial mammograms for women ages 50 to 74 a “B” grade.

That grade is significant because the Affordable Care Act mandates that payors cover tests receiving a “B” grade or higher from the USPSTF; those receiving a “C”—including mammograms for women ages 40 to 49—could potentially not be covered by insurers. Mammograms for women ages 75 and older received an “I” from the USPSTF, because it felt there was not enough evidence to either support such screening or come out solidly against it.

“The Task Force, the American Cancer Society, and many others have all affirmed that mammography is an important tool to reduce the risk of dying from breast cancer, and that the benefits of mammography increase with age,” Albert Siu, MD, chair of the task force, said in a statement. “We hope this growing convergence among distinct organizations gives women and their health care providers confidence in the science that supports mammography screening.”

A draft of the USPSTF recommendations was first released back in April 2015, resulting in months of public comments, debate, and legislation.

The two-year delay

It may be a while before providers or patients see any immediate effects of this announcement.

In December 2015, Congress passed a $1.1 trillion Omnibus Spending Bill, which included a two-year moratorium on implementation of the USPSTF recommendations on breast cancer screening. The moratorium consisted of language previously found in the Protecting Access to Lifesaving Screenings Act.

These USPSTF recommendations were one of 2015’s most talked-about topics, but another organization, the American Cancer Society (ACS), also updated its own breast cancer screening recommendations in 2015. The ACS concluded that women should  start receiving annual mammograms at 45 and continue until the age of 54. In addition, at age 55, women should transition to biennial mammograms, but also have the choice to continue getting them year to year.

Official statements

The American College of Radiology (ACR) and Society of Breast Imaging released a joint statement about the finalized recommendations, saying they “will result in thousands of unnecessary deaths each year and thousands more women enduring extensive and expensive treatment than if their cancer had been found early by an annual mammogram.”

“Moving away from yearly screening in women 40-and-older endangers women, would cause needless death and disfigurement of women, and would simply not be good breast cancer screening policy,” Debra Monticciolo, MD, chair of the ACR Breast Imaging Commission, said in a statement.

William T. Thorwarth, Jr., MD, ACR CEO, noted in the same statement that the two-year moratorium passed by Congress in December will have a huge impact on patients while also giving the industry time to properly react.

“This congressionally mandated delay will help providers continue to save tens of thousands of lives each year while the USPSTF recommendations and their creation process are vetted by breast cancer screening experts and lawmakers,” Thorwarth said. “Women and Congress need to remain vigilant so that coverage decisions based on these recommendations are not simply put into place by insurers when that is not the intent of the Task Force recommendation.”

Susan G. Komen also issued a statement on the announcement, saying screening tests recommended by a provider should be covered regardless of the patient’s age.

“The medical field is moving toward determining individual needs for screening based on a woman’s risk,” Judy Salerno, MD, Susan G. Komen president and CEO, said in the statement. “Rather than establishing higher age-based standards that create potential barriers to care, women should be able to make informed decisions about breast cancer screening, develop a schedule that is right for them with their health care provider, and be assured that the screenings they need will be paid for.”