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Richard Harris discusses mammogram guidelines

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Federal Panel Revisits Contested Recommendation On Mammograms

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Richard Harris discusses mammogram guidelines

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ROBERT SIEGEL, HOST:

Many women have read or heard conflicting information when it comes to mammograms - how often to get them, at what age to start, how forceful a doctor should recommend the procedure for women in their 40s. And now, as federal guidelines are being updated, many of these questions are coming up again. The guidelines could also affect insurance coverage for a procedure that millions of women currently get at no cost. NPR's Richard Harris reports.

RICHARD HARRIS, BYLINE: Before we get to the insurance issue, let's look at the science. The U.S. Preventive Services Task Force has just taken a new look at mammography for breast cancer screening, a topic they last studied in 2009.

MICHAEL LEFEVRE: The Task Force continues to evaluate the value of mammography, and that the value of mammography increases with age, and women between age 50 and 74 are likely to get the most benefit.

HARRIS: Doctor Michael LeFevre at the University of Missouri says the Task Force continues to recommend that women over 50 get a mammogram every other year. The committee is also standing by its recommendation for women ages 40 to 49.

LEFEVRE: Women in their 40s should be empowered with information about what the science tells us to help them make a decision - what fits them best.

HARRIS: The benefits in that age group are smaller, the Task Force found. That means it's more a matter of judgment whether the harms, including false alarms and unnecessary tests and sometimes even unnecessary treatment are worth the benefit. So it's not recommending mammography for women under 50 as a matter of course. Likewise, the Task Force looked into what to do about the issue of women with dense breast tissue. Mammography is more likely to miss tumors in these women, and some doctors now perform additional tests like ultrasounds.

LEFEVRE: We just can't say whether additional imaging is going to help these women live longer or better. And so the Task Force cannot recommend for or against additional imaging in women with dense breasts.

HARRIS: Likewise, the Task Force evaluated a new technology gaining popularity called 3-D mammography.

LEFEVRE: But we didn't find enough evidence to determine whether that technology actually improves health or lengthens life.

HARRIS: So all in all, status quo. Why, then, did the American College of Radiology put out a press release that says the updated guidelines could cost thousands of lives?

CAROL LEE: Well, the concern is that it will discourage women from having regular mammography, particularly women under the age of 50.

HARRIS: Doctor Carol Lee, a radiologist at Memorial Sloan Kettering Cancer Center, says the Task Force is essentially reopening old wounds because, once again, the federal guidelines aren't as forceful as some doctors think they should be. They emphasized potential harms, and, in her view, they discount the benefit. And that less-than-robust endorsement puts insurance coverage for mammography at risk for some women.

LEE: In 2009 when similar guidelines came out, it required literally an act of Congress to ensure that coverage for mammography for women younger than 50 was still included.

HARRIS: That insurance guarantee will expire, assuming that these draft recommendations are formally adopted later this year. That means advocates will have to go back to Capitol Hill to assure there's free mammogram coverage for women in their 40s under the Affordable Care Act.

LEE: Yes, in the past Congress has been quite sympathetic, but I don't know whether that will continue.

HARRIS: Many of these differences of opinion could be resolved if new technology could reduce the large number of false alarms in mammography and if laboratory scientists could devise a way to distinguish between small growths that are nothing to worry about versus those that can turn deadly. Doctor LeFevre says that work is ongoing, but the answers may not be in-hand five years from now when the Task Force reviews mammography yet again. Richard Harris, NPR News.

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