by Lisa Schlager
Few health issues have stirred as much debate as the guidelines surrounding screening mammograms for average-risk women. Recent changes in national guidelines threatened access to mammograms for women age 40-49. FORCE worked together with other groups to pass laws that assure continued access to mammograms for women in this age group.
At the heart of the controversy is a public health panel known as the U.S. Preventive Services Task Force (USPSTF). The USPSTF develops national prevention guidelines for many health conditions, assigning a grade to certain preventive services. The Patient Protection and Affordable Care Act (PPACA) requires most health insurers to cover 100% of the cost of any preventive services given an “A” or “B” rating with no out-of-pocket costs for the patient. Last May, the USPSTF proposed new breast cancer screening guidelines downgrading screening mammography for average-risk women ages 40-49 to a “C” grade. They also proposed that women begin mammograms at age 50, continuing every two years until age 74. The panel stated that evidence was insufficient to recommend earlier or more frequent screening for younger women, or women with dense breasts. In our May 9, 2015 blog, we shared our concerns about the proposed recommendations and how they may impact the ability of women ages 40-49 to receive mammograms. Despite wide public opposition, in January 2016, the USPSTF finalized its guidelines.
Further complicating the issue, in October 2015, the American Cancer Society (ACS) changed its own mammography guidelines. Although not directly linked to insurance coverage, many consumers and health care providers look to the ACS for guidance around cancer screening. The ACS recommended beginning annual screening mammograms at age 45, and every 2 years starting at age 55. The organization also recommended against clinical breast exams by a doctor—a change from their previous guidelines. FORCE submitted this response to the ACS new guidelines.
Both ACS and the USPSTF guidelines conflict with breast screening guidelines of other key professional organizations. This table shows the screening recommendations of different organizations.
While the guidelines being discussed are for “average risk” women, over 20% of breast cancers occur in women under the age of 50[i] and young onset cancers are more likely to be hereditary. Inadequate use of risk-assessment tools and genetics experts result in many women learning about their high-risk status only after they have been diagnosed with cancer—often detected by breast self-exam or mammogram. This is why FORCE is taking a strong position on these guidelines.
FORCE and other organizations worked with legislators on the “Stop the Guidelines” campaign, in support of the Protecting Access to Lifesaving Screenings (PALS) Act. Signed into law in December 2015, the PALS Act places a two-year hold on the USPSTF recommendations, so that they won’t impact mammography coverage by insurance companies. Under this law, women age 40 and older will continue to have access to screening mammography every 1 to 2 years with no out-of-pocket costs. The PALS Act allows government agencies to review current practices, hold hearings, and report to Congress on ways to improve the USPSTF guideline process. It’s a good first step in addressing gaps in access to care, but there is more that needs to be done. FORCE will continue its ongoing efforts to ensure that high-risk individuals have access to the services they need. Stay tuned for further updates on our other advocacy efforts.
- NCCN Guidelines for management of high-risk women
- Information on the USPSTF Guidelines on BRCA Risk Assessment, Genetic Counseling and Testing
- The Society of Breast Imaging End the Confusion campaign
Tags: brca, BRCA 1, BRCA 2, BRCA1, BRCA2, breast cancer early detection, breast cancer prevention, breast self exam, cancer prevention, HBOC, mammogram, previvor, prophylactic mastectomy, screening and prevention, USPSTF