In November 2009, a government-appointed panel, the U.S. Preventive Services Task Force (USPSTF) updated its 2002 recommendations on breast cancer screening which has sent thousands of women to their doctors and health plans requesting clarification.

Who is the USPSTF?

The USPSTF is an independent panel of experts in primary care and prevention that systematically reviews the evidence of effectiveness and develops recommendations for clinical preventive services.

What are the recommendations?

• Most women in their 40s should not routinely get mammograms.
• Women 50 to 74 should get a mammogram every other year until they turn 75, after which risks and benefits are unknown.
• The value of breast exams by doctors and by individuals is unknown.

Will Optima Health cover mammograms for women under 50+?

All health plans encourage their members and communities to get recommended preventive health screenings. With these new recommendations in place, health plans will be sharing this information with their members and determining how they will cover mammography screenings in the future. Optima Health will continue to cover mammograms for women 40+ as we do now.

What Other Authorities Are Saying

Other recognized authorities on breast cancer, such as the American Cancer Society and the American College of Radiology, are up in arms about the new recommendations and it is not yet known if they will revise their measures around mammography screening to reflect USPSTF recommendations.

• The National Cancer Institute (NCI) says, “NCI appreciates the USPSTF’s review and analysis of the data …however, the take-away message here is that each woman needs to consider her individual benefits and risks and discuss them with her health care provider before making a decision on when to start screening mammography and how often to get one.
• The American Cancer Society (ACS) says, “The ACS continues to recommend annual screening using mammography and clinical breast examination for all women beginning at age 40. When recommendations are based on judgments about the balance of risks and benefits, reasonable experts can look at the same data and reach different conclusions.”
• The American College of Obstetricians and Gynecologists (ACOG) says, “Fellows should counsel their patients that insurance coverage for ‘routine screening’ mammography may become variable and that patients should address this question with their insurers.”

Points to Consider

• Mammography continues to be an important tool in screening for and diagnosing breast cancer.
• Women should continue to discuss the issue of when to begin screening with their physicians.
• Health plans will likely cover mammography for women younger than 50 if recommended by their physician.
• These recommendations apply to the general population, not to women considered to be at high-risk or have a family history of breast cancer.
• Clinicians will continue to recommend screening for women with increased risk for breast cancer at earlier ages.

Statistics

According to the American Cancer Society of the 48,000 breast cancer deaths each year, 17 percent are women who were diagnosed in their 40s, as compared to 22 percent in their 50s.
The decision to get a mammogram should be a decision made between you and your physician.

For a complete overview of the new USPSTF recommendations, visit the Annals of Internal Medicine Web site.