Critics Blast Advice About Mammograms

(Nov. 18) -- Reactions to new government guidelines for breast cancer screenings have been visceral and immediate, and have sparked instant disagreement among doctors.

Those objecting to the shift scoff at the composition of the government-appointed panel and the fact that it only re-examined old data and never touched or questioned a living patient before making its decision.

"The work of this committee is reminiscent of a bad 1956 science-fiction movie," said Dr. Michael Harbut, director of the Center for Occupational and Environmental Medicine at Michigan's Karmanos Cancer Institute. "The man in charge of successfully guiding the rocket ship proclaims, 'Don't question me. I am a scientist. I know what I am doing,' as the vehicle crashes into the side of a mountain."

The U.S. Preventive Services Task Force urged that almost every breast cancer detection action that disease specialists have been hammering into their patients for years be overturned, a complete reversal of an earlier panel's ruling in 2002.

It says women should no longer do self-exams, that women in their 40s should stop routinely having annual mammograms and that older women should have them only once every other year. The panel concluded that such screenings often lead to false alarms and unnecessary biopsies, without substantially improving the odds of survival.

"We've been saving lives," said Dr. Constance Lehman, medical director of radiology and director of breast imaging at Seattle's Cancer Care Alliance, "and to have these trends reversed in a totally misguided effort to save money is just wrong."

However, while some physicians and organizations such as the American Cancer Society and the American College of Radiology are critical of the changes, several national patient support and advocacy groups think the shift is long overdue.

According to media reports, the National Breast Cancer Coalition and the National Women's Health Network welcomed the new guidelines.

Among those most loudly cheering the tightening of screening requirements are those women and their friends and families who have endured the anguish and fear that accompanies procedures demanded by a misread tumor or a shadow on an X-ray or scan.

But critics are concerned about the makeup of the task force: 13 physicians, two registered nurses and a psychologist. Most are specialists in family medicine, geriatrics, pediatrics, chronic diseases and OB/GYN. According to their bios provided to the government and others appearing online, most are more actively involved in formal research than in patient care.

Several members specialize in analyzing cost-benefit trade-offs and health economics. Others consult, work or have worked for major insurance and drug companies as well some of the nation's largest medical plans.

"It's a money issue," Lehman said.

"This group focused on how can we save money and cut costs," she said. "Unfortunately, the mathematical models that they used were based on data that was decades old. It doesn't reflect how we're practicing today."

Other physicians agreed on the likelihood of the financial motivation behind the recommendations.

"I think that they're taking a real risk for patients and probably just to decrease costs," said Dr. Lawrence Bassett, director of breast imaging at UCLA's Jonsson Comprehensive Cancer Center.

Physicians say the cancer community is very concerned that insurance companies and even the government will use the recommendations to justify disallowing payment for screenings.

Several physicians strongly criticized the composition of the panel, and some called the lack of cancer specialists, cancer surgeons, breast specialists or breast cancer patients "appalling."

"They need to have people at the table making these decisions include those who care for and treat patients with breast cancer," Lehman said.

Others were a bit more direct.

"It is fairly obvious that few, if any, of the committee members have any day-to-day responsibility for the preservation of life and the defeat of death," said Harbut, who is also clinical professor of internal medicine at Michigan's Wayne State University.

Even the agency that convened and funded the task force left room for doubt. As the panel's announcement dominated headlines across the nation, a disclaimer remained on the Web site of the U.S. Agency for Healthcare Research and Quality: "Recommendations made by the [task force] are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services."

A physician who participated in two earlier medical panels for the agency described the phrase as an attempt at "plausible deniability," or an effort to "avoid being the target for public anger over the decision."

The agency's press office and the Department of Health and Human Services have not responded to repeated requests to explain the disclaimer.

Meanwhile, cancer experts continue to worry about the future of cancer screening.

"The conclusion that this group offers is one that I would not bet my life on, nor that of my daughter, my wife, my sister, my mother or any of my patients," Harbut said.