Mammographic Screening Guidelines

The US Protective Services Task Force (USPSTF) was created in 1984 as an independent panel of experts in prevention and evidence- based medicine. The members come from the fields of primary care and protective services. The USPSTF is supported by the U.S. Department of health and human services agency. Their purpose is to evaluate scientific evidence to determine whether medical screenings, counseling, and preventative medication works for adults and children who have no symptoms.
The Obama Affordable Care Act was passed in 2009. The USPSTF was engaged to review the screening recommendations previously established for various types of cancer that were already in existence and recommend any changes.

The American Cancer Society (ACS), a grassroots nongovernmental organization was the first organization to recommend mammography screening in 1976. The ACS guidelines were modified several times as increasing evidence worldwide mounted that yearly mammography screening saves lives. This was proven by the decreasing death rates from breast cancer. In 2003, the ACS recommended yearly mammography screening for all women. Breast Cancer was no longer a death sentence due to early detection of smaller cancers. Women also had the opportunity to have conservative breast surgery rather than a mastectomy, and preserve the breast. Mastectomy results in a physical image-altering surgery. Oftentimes, knowing they have physical changes from surgical treatment, women did not seek medical treatment of any other visible changes of her breast, which is generally a sign of an advanced breast cancer. This results in a significant cost of life.
Before 2009, the USPSTF recommended mammography screening every 1-2 years beginning at 40. However, their guidelines changed after the passage of the Affordable Care Act. Now they recommend yearly screening beginning at age 45, and at 55 screen every other year until 74. They considered the anxiety of having an indeterminate screening mammogram report and a resultant call back for further evaluation, or possibly undergoing an in-office needle biopsy with benign results, a harm. To the patient the USPSTF felt that while saving a life is important, there are much fewer lives saved in this age group (40-49) than in the other age groups. Additionally, the task force concluded that there was insufficient evidence to recommend for or against screening women 75 or older.

Keep in mind:
The chances of an “at average risk” woman (a woman with no family history of breast cancer) increases as we get older

1 out of 64 forty year olds is diagnosed with breast cancer
1 out of 50 fifty year olds is diagnosed with breast cancer
1 out of 25 sixty year olds is diagnosed with breast cancer
1 out of 12 seventy year olds is diagnosed with breast cancer
1 out of 8 eighty year olds is diagnosed with breast cancer

What a lot of women and doctors do not know is that 80% of women diagnosed with breast cancer every year do not have a family history of breast cancer; 5-10% of breast cancers are genetically linked! One can also conclude that the average at risk woman is also at high risk.
When the USPSTF draft guidelines were released, there was a very important reason for women to be concerned. If the USPSTF draft recommendations were to be finalized as the new guidelines, this could give the private health insurance companies leeway to restrict or deny screening mammography reimbursement. After the new guidelines of the USPSTF were released, there was such an outcry by medical professional organizations and women, that these guidelines were not imposed. However, in the later part of 2015, after allowing time for people to voice their opinion to the task force recommends, the guidelines are likely to be implemented.

Fortunately, through the support of participating organizations such as:
National Consortium of Breast Centers
American Congress of Obstetricians and Gynecologist
American College of Radiology
American Women Unite for Breast Cancer Screening
Black Women’s Health Imperative
Bright Pink
Don’t be a Chump! Check for a Lump!
Force (Facing our Risk of Cancer Empowered)
Living beyond Breast Cancer
Men against Breast Cancer
National Association of Nurse Practioners in Women’s Health
National Hispanic Medical Association
National Patient Advocate Foundation
Prevent Cancer Foundation
Sharsheret
Society of Breast Imaging
Susan G. Komen
Tigerlily Foundation

As well as people responding resoundingly to the Change.org petition on the web.

Congress responded to include the Protecting Access to Lifesaving Screenings (PALS) Act in the omnibus spending bill to delay implementation of the USPSTF draft. The act would protect women’s access to mammograms by placing a two-year moratorium on the USPSTF draft recommendation for breast cancer screening. The USPSTF draft recommendations conflict with other key clinical organizations which would result in widespread confusion and put more than 22 million women at risk of losing insurance coverage for mammograms with cost sharing.