After a government panel kicked off a maelstrom by recommending that mammograms be curtailed for younger women and reduced overall, Health and Human Services Secretary Kathleen Sebelius urged calm.

"There is no question that the U.S. Preventive Services Task Force Recommendations have caused a great deal of confusion and worry among women and their families across this country. I want to address that confusion head on. The U.S. Preventive Services Task Force (USPSTF) is an outside independent panel of doctors and scientists who make recommendations. They do not set federal policy and they don't determine what services are covered by the federal government," she said in a statement on Nov. 18.

But a little known provision buried within the proposed Senate health care reform bill suggests that the USPSTF may have more clout than realized. The legal eagles at the American College of Radiology have curled up with the bill and found several sections that contain language stipulating that insurance entities such as private insurers, Medicare and Medicaid would only be required to cover services receiving a specific grade from the U.S. Preventative Services Task Force.

"Mammography [for younger women] does not have the required grade and would therefore be excluded from mandatory coverage by the Senate bill," said ACR spokesman Shawn Farley.

The American College of Radiology and Society of Breast Imaging issued a joint statement about the situation on Tuesday.

"[The Senate bill] would exclude mammography services for women 40-49, would only require coverage of biennial (every other year) coverage for women 50-74, and exclude coverage for those 74 and older. While these USPSTF recommendations may result in cost savings, a great many women will die unnecessarily from breast cancer as a result," the statement read. The groups urged Congress to protect annual mammography coverage and recommended that USPSTF recommendations be excluded from health care reform.

While the reform bill, which is coming up for debate shortly, does not mention the mammography recommendations specifically, the grade level requirements indicated in the bill suggest that Medicare would not be required to pay for wider mammography screening. Private insurers often follow the CMS lead. It is unclear how the measures would impact individual state requirements for mammography.

ACR reported to DOTmed News that about 30 percent of mammograms are performed in women 40-49, with a conservative death rate reduction of 20 percent. "You can see we are talking about a significant number of women who will die unnecessarily if these recommendations are adopted as policy," Farley cautioned.

A statistical as well as humane argument for screening younger patients is that if cancer is successfully treated in younger women, the years of life preserved are significant. "This age group [40-49], even according to the USPSTF paper itself, is where there is the greatest beneficial effect," Farley noted. "By saying that women [in this age group] should not get mammograms, [policymakers] are potentially if not literally giving the nation's second leading cancer killer at least a nine-year head start on patients and their doctors. This will lead to more advanced cancer...higher costs of treatment... and a much higher breast cancer death rate."

Read the groups' joint statement, which includes relevant data on benefits and concerns, and direct links to the relevant portions of the bill:
http://www.acr.org/HomePageCategories/News/ACRNewsCenter/ExcludedUSPSTFRecsFromHCR.aspx

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