AP graphic/Centers for Disease Control and Prevention
The recent recommendations on breast cancer screening by the US Preventive Services Task Force now have the White House on the defensive and critics citing them as a prize example of health-care rationing.
The Task Force now recommends that mammography, the most common screening tool for early detection of breast cancer, not be done routinely on patients younger than 50. This is in complete contradiction of their long-standing policy, reiterated as recently as six months ago, that women as young as 40 who were not undergoing mammography were risking their lives by not being screened. It also breaks with the long-held position of the American Cancer Society.
Since the announcement of the new recommendations, many critics in and out of Congress have decried the new recommendations. Rep. Marsha Blackburn (R-TN-7) flatly said that this was an example of rationing:
This is the way rationing, which my colleagues and I have warned about, will begin to enter the market place -- slowly, imperceptibly and lethally.
The American Cancer Society issued a statement saying something remarkably similar:
Our experts make this recommendation [for screening beginning at age 40] having reviewed virtually all the same data reviewed by the USPSTF, but also additional data that the USPSTF did not consider...The USPSTF says that screening 1,339 women in their 50s to save one life makes screening worthwhile in that age group. Yet USPSTF also says screening 1,904 women ages 40 to 49 in order to save one life is not worthwhile. ...With its new recommendations, the USPSTF is essentially telling women that mammography at age 40 to 49 saves lives; just not enough of them.
White House incoming Communications Director Daniel Pfeiffer issued a swift rejoinder, accusing critics, especially Fox News, of "twisting" information to suit a partisan agenda. He then said, as did HHS Secretary Kathleen Sibelius, that the Task Force was empowered to issue recommendations only, not to set policy. But whether the Task Force really has as little power as the Secretary says it has, is far from clear. The following paragraph from the Task Force official FAQ suggests that it might in fact have more power than the Secretary is willing to admit:
Primary care clinicians are the principal audience for U.S. Preventive Services Task Force (USPSTF) recommendations. Task Force recommendations also have informed recommendations developed by professional societies and the coverage policies of many health plans and insurers. The USPSTF has figured prominently in the development of health care quality measures and national health objectives.
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