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U.S. Preventive Services Task Force

Early Detection

USPSTF Moves Forward with Controversial Breast Cancer Screening Recommendations

Bright Pink is disappointed to hear that the United States Preventive Services Task Force (USPSTF) has chosen to proceed with finalizing their draft guidelines on breast cancer screening, despite legislation passed in Congress at the end of 2015 prohibiting the implementation of these guidelines for two years. The purpose behind the legislative moratorium is to allow for more inclusive discussion about the clinical impact these guidelines would have on American women, a process that is scheduled to begin in less than two weeks.

It’s still unclear why the USPSTF is moving forward with finalizing their guidelines, in clear contradiction with the law, and what the full implications of this decision will be, beyond generating even more confusion for women who simply want clarity on the question of when to get a mammogram. Thankfully, the President signed a bill in December that requires insurers to continue covering annual screening mammograms, as required under the Affordable Care Act, for women aged 40 and over through 2017.

The USPSTF guidelines recommend that women wait to start getting mammograms until age 50, and that they get them only every two years until age 74. This is true despite the fact that, according to the American Cancer Society, 25% of women who die from breast cancer are diagnosed in their 40s, and despite the fact that finding breast cancer at an earlier stage means that it’s more easily treated.

The recommendation to wait until age 50 is grounded the idea that mammograms cause women more harm than good in two key ways.

First, there’s concern that mammograms increase anxiety and cause women to undergo unnecessary biopsy procedures in response to suspicious mammogram findings. While no woman wants the stress of waiting for a follow up test and results, or of enduring a painful procedure, we believe the vast majority of women would prefer the former to a later-stage breast cancer diagnosis and all that comes with it. The USPSTF is concerned with women being able to balance the benefits and harms of mammography. But the harm of experiencing follow-up procedures is not equal to the benefit of not dying from breast cancer. In our opinion, the USPSTF is giving greater weight to avoiding those minimal harms than they are to very significant benefit of not dying from breast cancer.

Second, there’s concern that mammograms result in “over treatment” of non-invasive (or stage 0) breast cancer called DCIS. This cancer is contained to the milk duct, and may or may not ever spread and become life-threatening. Our belief is that the problem here is not with the screening modality, or with the fact that something abnormal was found through that screening, but with the treatment protocol. With greater understanding of how DCIS differs from invasive cancer, and on the risk factors associated with it, physicians can collaborate with their patients to develop more appropriate and personalized treatment plans that can reduce the chance for unnecessary treatment.

Bright Pink remains steadfast in our position that average-risk women should start getting mammograms at age 40, and that they should get them annually. We will watch with interest to see how the USPSTF’s latest actions play out in the context of the newly passed legislation, and will continue to advocate for young women around the country who deserve access to life-saving screenings.

Early Detection, Risk-Reduction Lifestyle

PALS Act Passes: Good News for Screening Access and Your Health

Today, we’re able to celebrate a development in the world of breast cancer screening that affects you and the women you love.

The Protecting Access to Lifesaving Screenings (PALS) Act was included in the Omnibus Spending Bill that Congress voted on and passed this week before leaving Washington D.C. for their holiday break. What does this mean for your access to mammograms? We broke down what you need to know…

What is the PALS Act?

The bipartisan PALS Act protects women’s access to mammograms by putting a two-year halt on the U.S. Preventive Services Task Force (USPSTF) draft recommendations for breast cancer screening. Bright Pink has been a vocal supporter of the PALS Act since its inception, alongside medical professional societies like the American Congress of Obstetricians and Gynecologists and the American College of Radiology, as well as other patient advocacy organizations like Susan G. Komen.

Pausing the implementation of USPSTF’s recommendations gives the medical community the time needed to voice their concerns about potentially harmful screening recommendations. As it stands, there has been little insight drawn from this community despite the fact that they are the ones who see the effects of guidelines like these among their patients. It also ensures that women have continued access to lifesaving breast screening while the USPSTF recommendations are fully debated.

What would’ve happened without the PALS Act?

The proposed USPSTF recommendations give annual mammograms for women ages 40–49 a “C“ rating. A C rating means that there is at least moderate certainty that the net benefit of the procedure is small and that the service is therefore best offered to patients only selectively. This directly contradicts the recommendations of other clinical organizations and would put more than 22 million women at risk of losing insurance coverage for mammograms without cost sharing.

We know how crucial regular screening beginning at age 40 can be for women — 1 in 8 women will develop breast cancer in her lifetime, yet if caught early, the five-year survival rate is close to 98%. Without the PALS Act, women may have found it harder to take action that will detect breast cancer early while it is still treatable.

How does it relate to the Omnibus Spending Bill that was just passed?

An Omnibus Spending Bill is a type of bill that aggregates many smaller appropriations bills (e.g. government spending bills) together, allowing Congress to vote on and pass all of them together with only one vote in the House and one vote in the Senate. The PALS Act was one of the appropriations bills included in this latest Omnibus Spending Bill.

What it means for you now….

During this two-year moratorium on the USPSTF’s recommendations, the medical and women’s health advocacy communities have the opportunity to take action and be more involved. And during this period, women in their 40s will continue to have access to valuable mammogram screenings. This is a decision that will affect millions of women. Bright Pink will continue to weigh in on the subsequent process as your advocate and we will let you know when and how you can make your own voice heard.

And in the meantime, its important to continue to have conversations with your doctor about developing a screening plan that addresses your personal and family medical history. Take time today to learn more about about breast cancer early detection, and to Assess Your Risk for breast cancer.

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