Experts question motives of mammogram guidelines

Cancer experts fear new U.S. breast imaging guidelines that recommend against routine screening mammograms for women in their 40s may have their roots in the current drive in Washington to reform healthcare.

Critics of the guidelines, issued on Monday by the U.S. Services Task Force, an independent panel sponsored by the U.S. Agency for Healthcare Quality, say the new guidelines are a step backward and will lead to more cancer deaths.

Here are some of their concerns.

* Dr Carol Lee, chairwoman of the American College of Radiology Breast Imaging Commission, said she fears insurers—both private and public—will use them to pare back health costs.

"These new recommendations seem to reflect a conscious decision to ration care,” Lee said in a statement.

She said since the onset of regular mammogram screening in 1990, the death rate from breast cancer, which had been unchanged for the preceding 50 years, has decreased by 30 percent.

* Dr Len Lichtenfeld, deputy chief medical officer of the American Cancer Society, said the influential group will not change recommendations for routine mammograms for women starting at age 40.

But he is worried that women will become so confused by the conflicting recommendations they will stop getting mammograms altogether. “Frankly, from our point of view that would be the worst possible outcome,” Lichtenfeld said in a telephone interview.

* Lichtenfeld and other doctors are worried that insurance companies and government insurers will seize on the recommendations as a way to control rising health costs.

“What is going to happen is insurers are going to say, ‘The U.S. Preventive Services Task Force doesn’t support screening. We’re not going to pay for it,’” said Dr Daniel Kopans, professor of radiology at Harvard Medical School and a senior radiologist at Massachusetts General Hospital in Boston.

“There were no new data to assess. One has to wonder why these new guidelines are being promulgated at a time when healthcare is under discussion and I am afraid their decision is related to saving money rather than saving lives,” Kopans said.

* “The USPSTF recommendations are a step backward and represent a significant harm to women’s health,” Dr W. Phil Evans, president of the Society of Breast Imaging, said in a statement.

“At least 40 percent of the lives saved by mammographic screening are of women aged 40-49,” Evans said. “These recommendations are inconsistent with current science and apparently have been developed in an attempt to reduce costs. Unfortunately, many women may pay for this unsound approach with their lives.”

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* Experts worry insurers will stop paying for screening

* Some see attempts to ration care to cut costs

By Julie Steenhuysen

CHICAGO (Reuters)

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