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Several sections of Senate health care reform legislation contain language stipulating that insurance entities such as private insurers, Medicare and Medicaid would only be required to cover services receiving a specific grade from the U.S. Preventative Services Task Force.

Presently, this would exclude mammography services for women 40-49, would only require coverage of biennial (every other year) coverage for women 50-74, and exclude coverage for those 74 and older. While these USPSTF recommendations may result in cost savings, a great many women will die unnecessarily from breast cancer as a result. This is not a political argument. It is a matter of life and death. Congress needs to act to specifically protect annual mammography coverage for women ages 40 and older and for high risk women under 40 as recommended by their physician," said James H. Thrall, M.D., FACR, chair of the American College of Radiology (ACR) Board of Chancellors. "If the cost cutting USPSTF mammography recommendations are not excluded from health care reform legislation, the government or private insurers would be permitted to refuse women coverage for this life-saving exam, turning back the clock on two decades of advances against the nation's second leading cancer killer." The federally funded and staffed Task Force includes representatives from major health insurers, but does not include a single radiologist, oncologist, breast surgeon, or any other clinician with demonstrated expertise in breast cancer diagnosis or treatment.The new recommendations run counter to even the Task Force's own data and are out of touch with the long-proven policies of the American Cancer Society (ACR) and other experts in the field

The benefits vs. concerns of annual screening mammography starting at age 40

• It is well known that mammography has reduced the breast cancer death rate in the United States by 30 percent since 1990 - hardly a small benefit.

• Based on data on the performance of screening mammography as it is currently practiced in the United States, one invasive cancer is found for every 556 mammograms performed in women in their 40s.

• Mammography only every other year in women 50-74 would miss 19 to 33 percent of cancers that could be detected by annual screening.

• Starting at age 50 would sacrifice 33 years of life per 1,000 women screened that could have been saved had screening started at age 40.

• Eighty-five percent of all abnormal mammograms require only additional images to clarify whether cancer may be present (or not). Only 2 percent of women who receive screening mammograms eventually require biopsy. The USPSTF data showed that the rate of biopsy is actually lower among younger women.

The issue of overdiagnosis is controversial. By the Task Force's own admission, it is difficult to quantify and is less of a factor among younger women who have many years of life expectancy. Weighing the significant, documented benefits of annual mammography screening against possible anxiety and need for additional imaging or biopsy, it is difficult to understand how the USPSTF reached its recommendations. The USPSTF is a panel funded and staffed by the HHS Agency for Healthcare Research and Quality (AHRQ). The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) gave the U.S. Department of Health and Human Services the authority to consider USPSTF recommendations in Medicare coverage determinations. Private insurers may also incorporate the USPSTF recommendations as a cost-savings measure.

Source: American College of Radiology

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