Top Doctor Speaks out Against Proposed Changes to Breast Cancer Screening

Friday, December 11, 2009 Cancer News
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NEW YORK, December 10 The Editor-in-Chief of CancerInvestigation and one of the country's most respected medical policyprofessors has written a new commentary which criticizes proposed changes tobreast cancer screening. The federally-funded US Preventive Services TaskForce (USPSTF) has recommended an about-turn in breast cancer screening,which includes recommending against routine screening in the 40-49 year oldrange, screening only every other year in older women and explicitlyrecommending against teaching women breast self-examination (BSE).

"In the current healthcare reform debate in the United States, few issueshave generated more opinions and greater confusion than the value of cancerscreening," says Dr Gary H Lyman, Editor-in-Chief of Cancer Investigation andProfessor of Medicine and Director of Comparative Effectiveness and OutcomesResearch at Duke University and Senior Fellow at the Duke Center for ClinicalHealth Policy Research.

"When a government-commissioned panel makes major changes in medicalrecommendations that have been in place for many years and are still held bymost other professional organizations without any substantial change in theavailable evidence, it is essential that they be aware of the enormousadverse impact that these changes may have on patients, their physicians andon the broader issues at stake in healthcare reform."

The new USPSTF guidelines fly in the face of those from the AmericanCollege of Physicians, the National Comprehensive Cancer Network, theAmerican Medical Association, the American Academy of Family Physicians, theAmerican College of Obstetrics and Gynecology and the Canadian Task Force onPreventative Health Care and, until recently, their own organization.

Routine screening also saves thousands of lives and experts say that evena small increase in the occurrence of more advanced disease resulting fromless frequent screening may have a long term adverse impact not only onwomen's lives, but also on overall healthcare costs. In addition, modelingstudies show that maximum life years for patients are achieved by initiatingscreening at age 40 years.

"There is an immediate and compelling need for major healthcare reform inthe USA and we can no longer afford to stand still and waste limitedresources for ineffective interventions while millions of Americans gowithout access to proven effective screening and treatment," concedes DrLyman. "However, available, effective and safe measures such as breast cancerscreening should not become the focus of this debate.

Efforts to improve the survival and quality of life for women with breastcancer require the rational application of any and all proven effectivestrategies including screening, mammograms and BSEs. While Lyman agrees thatmore research is needed, he warns that the suggested changes in screening arelikely to lead to greater confusion and a reduction of breast screeningefforts, which may cost patient lives.

In addition, Dr Lyman points out two real and opposing dangers that mayemerge from the controversy around the new USPSTF recommendations for breastcancer screening.

"First, the Center for Medicare and Medicaid Services or private insurerscould act on the suggestions of the federally-funded USPSTF and reverse theirpolicy of reimbursement for breast cancer screening, adding further to thebarriers women already face to appropriate breast cancer screening.

"Secondly, and perhaps of even greater concern, is the potential for theconfusion and anger surrounding the new recommendations being labeled byopponents of healthcare reform as an example of rationing and what willhappen when the government takes over healthcare in the US.

"We cannot allow this debate over breast cancer screening to strengthenopposition to the best opportunity to date for meaningful and long overduehealthcare reform that will provide access to important healthcare advancesto all Americans," says Dr Lyman.

Cancer Investigation is published by Informa Healthcare. Please visit

SOURCE Informa Healthcare

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