A Ban on Mammograms?

A recent study published in BMJ looked at 90,000 women over 25 years, randomly dividing the group into some that received screening mammography and others that did not. The findings showed no difference in mortality; however in the mammography group there was a slight risk of over-diagnosis (1 over-diagnosis per 424 women screened). You can read the study for yourself or this excellent review by Dr. Aaron Carroll at the Incidental Economist.

We have been down this road before. Dr. Lisa Maurer reviewed a 2009 study which similarly informed the scientific community that in saving lives from breast cancer.* As a result of this and other studies, the United States Preventive Services Task Force (USPSTF) changed their recommendations regarding screening mammography in November 2009.

Essentially, the USPSTF said that in individuals under the age of 50 routine screening mammography was not something to be performed in every person. However, clinicians might choose to do so for their patients depending on individual circumstances. This change occurred contemporaneously with the debate over the Affordable Care Act in Congress. An ** added the following text to the Affordable Care Act:

 “the current recommendations of the United States Preventive Services Task Force regarding breast cancer screening, mammography and prevention shall be considered the most current other than those issued in or around November 2009.”

Because the Affordable Care Act requires health insurers to cover USPSTF recommended services, the Vitter amendment essentially overruled the science and now requires insurance coverage for routine screening mammography for all women over age 40. In light of the recent BMJ study, these words in the law will result in over-diagnosis, over-treatment, and excessive health care costs (on a population level) without improvement in breast cancer death rates. Unless, of course, the amendment is repealed or until the USPSTF issues new recommendations.

by

Cedric Dark, MD, MPH

**Mea culpa – I have attributed this amendment to Senator Barbara Mikulski (of the Great State of Maryland) in the past and I’m personally relieved that this amendment was not hers.

*There is a great counter to the interpretation of the BMJ study at the Project Millennial blog