There are a lot of worries surrounding this week’s new breast screening guidelines from the U.S. Preventive Services Task Force. Women and their doctors must now decide whether to follow the old recommendations, for annual mammograms after age 40, or the new ones, which call for mammograms to begin at 50 and to take place just every other year.
And what if they choose the old guidelines? Will their insurance companies still cover the cost of annual exams? Will the decade of mammograms between age 40 and 50 be paid for, or will they become out-of-pocket costs for women patients who choose to have them?
So far, so good. USA Today interviewed several of the country’s biggest health insurance companies, all of whom said they would continue to pay for annual mammograms beginning at age 40. Some of the companies interviewed were Kaiser Permanente, Aetna, Cigna, Geisinger Health Plan, Group Health Cooperative and WellPoint, which operates Blue Cross/Blue Shield plans in 14 states.
Nationwide, these plans cover more than 73 million people.
From the USA Today story:
“A spokeswoman for Kaiser Permanente, Farra Levin, says, "We believe that focusing on prevention and early detection is critical in improving women's health and saving lives."
“That doesn't mean that companies are totally ignoring the task force's advice.
“A spokeswoman for WellPoint, Jill Becher, says the company considers the task force's recommendations, but also weighs advice from the American Cancer Society and American College of Obstetrics and Gynecology, which still recommend annual screenings beginning at age 40.
“Group Health Cooperative, among others, plans to look at the task force's recommendations next year, says spokesman Michael Foley, but it would still pay for the screening.”
Secretary of Health and Human Services Kathleen Sebelius has said that government support for annual mammograms after 40 is not changing. Medicare will still pay for one mammogram for women between the ages of 35 to 39 and annual screenings after that.
But it’s clear that there could be changes in this arena. The recommendations have only been out for three days, and they have caused a perfect storm among alarmed patients, angry doctors, premiere cancer hospitals and concerned umbrella organizations and policymakers. The real battle is certain to ensue down the road, when costs of providing health care continue to rise and insurance companies examine what they will and will not provide.
This morning on Good Morning America, a member of the task force defended the panel’s work.
“"This is not a recommendation to not screen,” said Dr. Timothy Wilt during an interview on the morning show. “It's a recommendation to provide women with the facts, Our recommendations support an individualized decision-making process with the women so that they have knowledge about the risk and benefits associated with mammography screening."
Wilt said the panel was not affected by cost considerations or insurance company influences.
"Cost is not considered at all. This is about providing high quality health care for the individual [and] providing the information they need to know to make an informed decision," he said. "The information is based on eight very large, randomized, controlled trials of mammograms in women, a series of six different databases and a variety of other studies."
From GMA:
“Wilt said that according to the task force's research, the benefits of saving about one life out of every 2,000 through mammograms for women between the ages of 40-49 "needs to be balanced" with the sometimes serious harms that come with mistreatment and over-treatment.
"We place great value in being able to reduce a death occurrence in breast cancer, [but] that occurs very rarely -- one in about 2,000. The other 1,999 wouldn't benefit," Wilt said. "Up to 30 percent of breast cancers would never progress to the point that they would ever be noticed in a woman's lifetime. We often treat those. They may be unnecessary treatments [resulting in] pain and disfigurement from surgery.
"Those harms that occur with many women need to be balanced out with the benefits for a few," he said.
“The report "shouldn't be dismissed," Sebelius said on CNN's "The Situation Room." But she added, The task force is "making recommendations, not coverage decisions, not payment decisions."
Sebelius said women must be their own advocates in listening to and deciding what to do regarding the new guidelines.
"My message to women is simple," Sebelius said. "Mammograms have always been an important life-saving tool in the fight against breast cancer and they still are today. Keep doing what you have been doing for years -- talk to your doctor about your individual history, ask questions and make the decision that is right for you."
The USA Today story:
http://www.usatoday.com/news/health/2009-11-19-1Amammogram19_ST_N.htm
The Good Morning America story:
http://www.abcnews.go.com/GMA/HealthyLiving/us-preventative-services-task-force-member-timothy-wilt/story?id=9124113
The CNN story and video clip of HHS Secretary Kathleen Sebelius:
http://www.cnn.com/2009/HEALTH/11/18/mammogram.guidelines/