Understanding The Role of the U.S. Preventive Services Task Force (USPSTF)

In November 2009, the U.S. Preventive Services Task Force (USPSTF) published new guidelines for breast cancer screening by mammograms which sparked controversy on a vital topic to cancer organizations worldwide, the importance of early cancer detection. These new guidelines are a significant shift from those issued in 2002, which at that time, recommended women ages 40 and older to have an annual mammogram. The new recommended ages by the USPSTF to screen women for breast cancer is now 50 and older, leading to many questions on why such a change in policy is necessary.
Immediately after this recommendation from the USPSTF, a statement from Otis W. Brawley, M.D., chief medical official of The American Cancer Society, stated, “The American Cancer Society continues to recommend annual screening using mammography and clinical breast examination for all women beginning at age 40….reasonable experts can look at the same data and reach different conclusions….the Society’s panel found convincing evidence that screening with mammography reduces breast cancer mortality in women ages 40-74…. With its new recommendations, the USPSTF is essentially telling women that mammography at age 40 to 49 saves lives; just not enough of them… The most recent data show us that approximately 17 percent of breast cancer deaths occurred in women who were diagnosed in their 40s.” According to the American Cancer Society’s cancer statistics, this 17% represents approximately 7,000 lives, which will be left at risk once these breast cancer screening policy changes take effect.
Additional support for breast cancer screening comes from researchers at the University of London, which conducted two studies looking into the risks and benefits of breast cancer screening. The first study predicted the number of women who would have died from breast cancer in Britain without screening. The second study evaluated the number of deaths among 80,000 Swedish women with access to screening programs. The results published in the Journal of Medical Screening showed that for every 28 breast cancer diagnoses between 2 and 2.5 lives were saved. The results from the Swedish study indicated that for every 350 women screened for 10 years for breast cancer, one life would be saved. This research, along with hundreds of other publications, indicates an opportunity for saving lives from further development and implementation of cancer screening.
As stated on the Agency for Healthcare Research and Quality’s website (www.ahrq.gov), the USPSTF mission is “to improve the safety, quality, efficiency, and effectiveness of health care for all Americans.” The recommendations of the USPSTF are considered to be the “gold standard” for clinical preventive services, and are followed by almost every major primary care and federal agency associated with health care. USPSTF recommendations are used in undergraduate and post-graduate medical and nursing education as a key reference for teaching preventive care.
So what is the reasoning behind the USPSTF’s breast cancer screening recommendation? False positives can lead to psychological distress, unnecessary imaging tests and biopsies in women without cancer, and inconvenience due to false-positive screening results. Radiation exposure, although a minor concern from mammograms, is also a consideration. The USPSTF recommends that physicians be required to consider additional factors, such as an individual’s personal risk of having cancer, before conducting screening procedures such as mammograms.
It is up to the individual and his/her doctor to determine if screening tests will be implemented. If the health care provider does not cover screening tests which are preferred by the patient, other options are available from the private sector to address these needs at the patient’s own cost.
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References:
1. Agency for Healthcare Research and Quality, Rockville, MD
2. American Cancer Society (ACS) American Cancer Society Responds to Changes to USPSTF Mammography Guidelines. http://www.cancer.org/docroot/MED/content/MED_2_1x_American_Cancer_Society_Responds_to_Changes_to_USPSTF_Mammography_Guidelines.asp
3. American Cancer Society (ACS) Cancer Statistics 2009. http://www.cancer.org/docroot/PRO/content/PRO_1_1_Cancer_Statistics_2009_Presentation.asp
4. Duffy, S., McCann, J., Godward, S., Gabe, R., Warwick, J. “Some issues in screening for breast and other cancers.” Journal of Medical Screening. 2006; 13(Suppl1): S28-S34
5. U.S. Preventive Services Task Force. Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2009;151:716-26, W-236. [PMID: 19920272]