A House of Representatives hearing to examine the science behind a controversial policy on mammography yesterday erupted in a donnybrook.
Conservative members of the Energy Subcommittee and Commerce Health pounced on recommendations to cut back on mammography issued November 16 by the Preventive Services Task Force of the United States a health group appointed by the government councilors, as an example of the bad things that would happen if the current health reform plans moving forward. The Working Group indicated that healthy women should not start routine mammograms until age 50 (the previous council was to begin at 40). Even then, he said, mammograms should be performed every two years as opposed to every year. The working group also recommended that doctors not teach healthy women do regular breast self-exams. The reason in both cases: the aggressive screening tends to produce a psychological unnecessary stress, biopsies and surgery-night that outweigh the benefits for younger women
Representative Joe Barton (R-TX) blasted retirement aggressive working group. screening as a kind of "rationing" -a step Medical along "the path of socialized medicine in this country." Barton and others argued that the working group was trying to reduce medical costs and his new board would cause some women to die. Republican members of the subcommittee also said the new board was a taste of what the health care reform bill House-passed would bring, if adopted. Representative John Dingell (D-MI), a funder of the project of the health reform law, retorted that he was surprised to hear these "fairy tales. ... It's like listening to the Brothers Grimm. "Dingell deplored" the fear tactics. "And then the experts spoke.
The working-group leaders key witnesses Diana Petitti, a biomedical informatics expert at Arizona State University, Tempe, and Ned Calonge, chief medical officer at the Colorado Department of Health in Denver have been scattered questions about why their group had decided to reverse the earlier advice on mammography. (A 02 task force, with different members, recommended annual mammography beginning at age 40) and Petitti Calonge said the decision to deemphasize mammography based on a new review of the best and most recent evidence. Some members of Congress pressed them to recognize that the working group had a goal to reduce unreported medical costs. Both denied. "Cost was not a factor in our considerations," said Petitti. She and Calogne conceded they could have done better in a couple of ways, however. They said that the court did not fully involve the "stakeholders" in its review and recommendations have been poorly formulated Rather than discourage mammography for women in their 40s, what they meant, according to their testimony, was: ".. The decision to have mammograms for women in their 40s should be based on a discussion between a woman and her doctor "
Otis Brawley, a breast cancer specialist and chief medical officer of the American cancer Society, said ACS disagreed with the recommendation that regular mammograms delayed until the age of 50 an ACS panel reviewed the evidence in 07 and reached a different conclusion, he said the women earn more than they lose if they start mammograms at age 40. "experts can look at the science and disagreement" Brawley said. But he approved the conclusion of the working group within self-exams monthly produce too many false alarms and unnecessary biopsies. instead, ACS recommends "breast awareness", an approach that encourages women to be alert to physical changes, but not to the rigorous search for them.
An unscientific delivered what may have been the strongest critic of the day. Fran Visco, a lawyer, a survivor of breast cancer for 22 years, and president of the National Breast Cancer Coalition, called for less emotion and more reason. She said her organization supported the working group and its scientific approach. She added that there is nothing new about the furor it caused
Many of the audience were shocked by the changes in breast cancer screening guidelines but these guidelines and this controversy is not new. ... A National Institutes of Health consensus panel came to similar conclusions in 1997. In fact, historically, scientific evidence did not support the methods of breast cancer screening that have been promoted vigorously in our country . Today we have more evidence and understanding of breast cancer, but it seems that once again, the emotion and the conventional wisdom prevail over science, evidence and progress. Because a health message has been given over and over again and has become ingrained in the public consciousness does not make it okay. ... Too many times ... beliefs seized when there was actually no real evidence behind, and these actions caused harm to women.
Two other witnesses Donna Sweet of the American College of Physicians and Jennifer Luray Susan G. Komen for the Cure foundation, a group of patient advocacy, offered support for the group work but are concerned about the public reaction. Sweet said her organization recommends that women between 40 an 49 years consult their doctor and make an individual decision about mammography. Luray said that "there is enough uncertainty about the age at which mammography should begin and the frequency of screening that we do not want to see a change in policy for screening mammography at this time."
Subcommittee Chair Frank Pallone (D-NJ) ended the session by saying he had hoped to examine the evidence behind the conclusions of the working group, but that the whole issue had become " totally politicized ". He apologized "on behalf of the Congress."
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