When I resigned from the staff of the U.S. Preventive Services Task Force to return to academia, I said that one of my reasons was to give the USPSTF one more "private sector ally" by being freed to "speak my mind" about the adverse effects of political interference with the scientific process. Well, I'm speaking my mind now. Below is the text of a press release that my institution issued last week regarding the Task Force's soon-to-be-finalized updated recommendations on screening for breast cancer.
As the U.S. Preventive Services Task Force (USPSTF) prepares its final breast cancer screening recommendations, Georgetown family medicine physician Kenneth Lin, MD, MPH, points out that, regardless of what the USPSTF decides, the U.S. Congress has already preemptively overruled them.
In the 2016 spending bill (H.R. 2029), passed in mid-December 2015, Congress included language (Sec. 229) that selectively negated a provision of the Affordable Care Act that requires private health insurance plans to provide preventive services recommended by the USPSTF free of charge (without copayments or deductibles). In essence, the act requires insurers to disregard the USPSTF’s most recent determinations about the benefits and harms of breast cancer screening, dictating that the task force’s 2002 recommendations continue to determine insurance reimbursement.
“The U.S. Congress thinks it's perfectly acceptable, even preferred, for a scientific document from 14 years ago to guide coverage policy on screening for breast cancer in women,” says Dr. Lin, a former USPSTF staff member and a nationally recognized expert on cancer screening in primary care.
“As the American Cancer Society concluded in its 2015 guidelines, scientific evidence shows that a strategy of starting screening mammography later than age 40 may significantly reduce harms for many women. Thus, the decision about when to start screening should not be reflexive, but rather a shared decision between a woman and her doctor. The action taken by Congress does not serve women well and ignores medical and scientific advances in understanding the benefits and harms of screening,” Lin says.
He adds, “In 2002, the Palm Pilot was state-of-the-art, handheld technology, virtually no doctors used electronic medical records and Medicare did not cover prescription drugs for seniors. What patients would want to go back to those primitive days? But Congress wants to turn back the clock to 2002 on breast cancer screening.
“As a country, we have spent hundreds of millions of dollars researching ways to reduce the burden of breast cancer that cause the least harm to women. Allowing politicians to cherry-pick scientific guidelines that suit their agendas best will do lasting damage to women’s health,” Lin concludes.