American Association for Cancer Research



                                                                                                    DECEMBER 2009



Task force apologizes for poorly communicating recommendations to the public

In response to a firestorm that erupted last month over newly updated guidelines on breast cancer screening, lawmakers recently invited leadership of the federally-appointed task force responsible for the report as well as members of the advocacy community to Capitol Hill last Wednesday in an effort to sort through some of the confusion and controversy.

The guidelines were released by the U.S. Preventive Services Task Force and published on Nov. 17 in the Annals of Internal Medicine. They modify existing screening standards to recommend that women discuss the risks and benefits of mammography screening with their doctor, rather than automatically begin annual screening at age 40. Additionally, the guidelines advise less frequent mammograms for women between 50 and 74. Physicians are also encouraged to promote general breast awareness rather than teach women how to conduct formal breast self-examinations.

Not only did the guidelines, and the media blitz that ensued, trigger a great deal of confusion for women, they added fuel to an already bitterly contentious debate over health care reform occurring in Congress.

"The controversy that was ignited by the report may be eclipsing what the report says," said Representative Frank Pallone (D-NJ), chairman of the House Energy and Commerce Committee Subcommittee on Health, as he opened the hearing last Wednesday and explained the hearing's purpose to clarify how the recommendations came about, how they should be viewed, and what exactly they mean.

The panelists representing the task force immediately found themselves the targets of Republican members who charged that the guidelines represent a step toward rationed care and illustrate the dangers of government involvement in health care. The issue of breast cancer screening and the science behind the recommendations were largely lost during the hearing to the larger issue of health care reform and a partisan back and forth between lawmakers.

Ned Calonge, M.D., M.P.H., chair of the task force, and Diana B. Petitti, M.D., M.P.H., vice chair, repeatedly emphasized that their analysis was based on scientific evidence without cost consideration or political influence and that the intention of releasing the guidelines was to facilitate informed decision-making between women and their doctors. Petitti explained that her hope for the guidelines was to move the discussion toward individualized screening rather than the "rehashing of old data" that has occurred, but she accepted that the task force held much of the blame for not communicating the guidelines to the public more clearly.

The other panelists at the hearing offered mixed reactions to the guidelines. Otis Webb Brawley, M.D., of the American Cancer Society, conceded that mammography screening is not perfect, but criticized the report saying that, "we must stop sending messages that a screening and early detection test is of little or no value. We need to encourage women to get this test because it has shown to save lives." Only more research, he said, will improve prevention and early detection methods.

The American Cancer Society, along with Susan G. Komen for the Cure, which was represented by its president, Jennifer Luray, have each publicly expressed concerns with the guidelines and intend to continue recommending that women begin annual mammograms at age 40.

Fran Visco of the National Breast Cancer Coalition took a slightly different perspective, "because a health message has been given over and over again and has become rooted in the public consciousness does not make it correct. Indeed, too many times, policy, messaging and beliefs have taken hold when there was, in fact, no real evidence behind them, and these actions resulted in harm to women."

Ultimately, all agreed that there are flaws with mammography screening and more work needs to be done to improve detection methods.  


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