Comments and Response on the USPSTF Recommendation on Screening for Breast Cancer
Authors: Anita Ho
Journal: Annals of Internal Medicine (2010)

Letters20 April 2010Comments and Response on the USPSTF Recommendation on Screening for Breast CancerFREEAnita Ho, PhDAnita Ho, PhDFrom University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-152-8-201004200-00207 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:The USPSTF (1), regarded by many medical professionals as a premier source of information on preventive services (2), was blind-sided by the recent controversy regarding its recommendation against routine screening mammography for asymptomatic women younger than 50 years. Although the evidence-based panel prides itself on being independent of advocacy groups or managed care organizations, the controversy can be better understood if we consider the sociopolitical context of women's health and health care reform. Historically, women have had substantially less access to some of the major diagnostic and therapeutic interventions than men (3), were more likely to delay or forgo necessary medical care, and expressed more concerns about the quality of health care they received (4). The panel's recommendations may have prompted many to perceive, correctly or incorrectly, that the guidelines were a setback in the promotion of women's health.In the midst of discussions on health care reform, the public's response may also reflect its skepticism of scientists' claim of value neutrality in evidence-based medicine and their social authority based therein. After all, even if scientific evidence is the most important factor in the panel's recommendation, choosing which conditions create a large enough burden of suffering on society to warrant the USPSTF's investigation is partly a value judgment (5). Because the USPSTF's ratings influence insurance coverage of various preventive services, the public's flat-out rejection of the panel's conclusion may be a result of its distrust in the social authority of expert opinion, confusion about the panel's decision-making process, and concern about how rationing and funding priorities are determined by these experts.In responding to accusations that its recommendations were politically and economically driven, the USPSTF adamantly denied any financial considerations. Instead of convincing the public of its neutral stance, the USPSTF may have inadvertently perpetuated the impression that financial considerations in health care are never legitimate. As the country continues its debate on health care reform, the USPSTF and government officials may want to use this controversy as a new opportunity to facilitate more informed and responsible discussions among citizens regarding the planning and funding of health care programs. Rather than simply denying that economic or social context plays any role in scientific review, it may be more useful for the USPSTF to clearly explain what values were part of the consideration, how such values were chosen, and why such values were appropriate in determining its guidelines.Anita Ho, PhDUniversity of British ColumbiaVancouver, British Columbia V6T 1Z4, CanadaReferences1. U.S. Preventive Services Task Force. Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2009;151:716-26, W-236. [PMID: 19920272] MedlineGoogle Scholar2. Eisenberg JM, Kamerow DB. The Agency for Healthcare Research and Quality and the U.S. Preventive Services Task Force: public support for translating evidence into prevention practice and policy. Am J Prev Med. 2001;20:1-2. [PMID: 11306223] CrossrefMedlineGoogle Scholar3. Segev DL, Kucirka LM, Oberai PC, Parekh RS, Boulware LE, Powe NR, et al. Age and comorbidities are effect modifiers of gender disparities in renal transplantation. J Am Soc Nephrol. 2009;20:621-8. [PMID: 19129311] CrossrefMedlineGoogle Scholar4. Salganicoff A, Beckerman JZ, Wyn R, Ojeda V. Women's Health in the United States: Health Coverage and Access to Care. Washington, DC: Henry J. Kaiser Family Foundation; 2002. Accessed at www.kff.org/womenshealth/20020507a-index.cfm on 3 February 2010. Google Scholar5. Harris RP, Helfand M, Woolf SH, Lohr KN, Mulrow CD, Teutsch SM, et al; Methods Work Group. Third US Preventive Services Task Force. Current methods of the US Preventive Services Task Force: a review of the process. Am J Prev Med. 2001;20:21-35. [PMID: 11306229] CrossrefMedlineGoogle Scholar Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAuthors: Anita Ho, PhDAffiliations: From University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada.Acknowledgment: The author thanks Dave Unger, MD, and Suze Berkhout for their critical and constructive comments on an earlier draft.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoScreening for Breast Cancer: U.S. Preventive Services Task Force Recommendation StatementU.S. Preventive Services Task Force* When Evidence Collides With Anecdote, Politics, and Emotion: Breast Cancer ScreeningThe EditorsComments and Response on the USPSTF Recommendation on Screening for Breast Cancer Diana Pettiti and Ned Calonge Comments and Response on the USPSTF Recommendation on Screening for Breast Cancer Peter B. Dean Comments and Response on the USPSTF Recommendation on Screening for Breast Cancer R. Scott Braithwaite Comments and Response on the USPSTF Recommendation on Screening for Breast Cancer Mitchell H. Gail and Catherine Schairer Comments and Response on the USPSTF Recommendation on Screening for Breast Cancer Colin B. Begg Comments and Response on the USPSTF Recommendation on Screening for Breast Cancer Richard Yoast Comments and Response on the USPSTF Recommendation on Screening for Breast Cancer Victoria L. Seewaldt Comments and Response on the USPSTF Recommendation on Screening for Breast Cancer Nananda F. Col , Moritz H. Hansen , Baruch Fischhoff , and Steven G. Pauker Metrics Cited byPersonalizing Age of Cancer Screening Cessation Based on Comorbid Conditions: Model Estimates of Harms and BenefitsIris Lansdorp-Vogelaar, PhD, Roman Gulati, MS, Angela B. Mariotto, PhD, Clyde B. Schechter, MD, MA, Tiago M. de Carvalho, MSc, Amy B. Knudsen, PhD, Nicolien T. van Ravesteyn, PhD, Eveline A.M. Heijnsdijk, PhD, Chester Pabiniak, MSc, Marjolein van Ballegooijen, MD, PhD, Carolyn M. Rutter, PhD, Karen M. Kuntz, ScD, Eric J. Feuer, PhD, Ruth Etzioni, PhD, Harry J. de Koning, MD, PhD, Ann G. Zauber, PhD, and Jeanne S. Mandelblatt, MD, MPHQuality varies across clinical practice guidelines for mammography screening in women aged 40–49 years as assessed by AGREE and AMSTAR instrumentsWhen Evidence Collides With Anecdote, Politics, and Emotion: Breast Cancer ScreeningThe Editors 20 April 2010Volume 152, Issue 8Page: 542-543KeywordsBreast cancerCancer screeningConflicts of interestEvidence based medicineHealth careHealth care qualityMammographyObstetrics and gynecologyScientists ePublished: 20 April 2010 Issue Published: 20 April 2010 Copyright & PermissionsCopyright © 2010 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...