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Senator strikes out by politicizing mammography recommendations

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US Senator David Vitter (R-LA) wrote to HHS Secretary Kathleen Sebelius last week requesting that she have the Agency for Healthcare Research and Quality remove from its website last Fall’s breast cancer screening recommendations from the US Preventive Services Task Force. Vitter writes:

“The recommendations were ill-conceived from the start – developed via a process without transparency, without input from those with experience and expertise in the field, and without due regard for the thousands of lives that could be impacted by the recommendation. They represent a step backward in our fight against a horrible disease and the taxpayers’ dollar must not be spent in further promotion of them.”

He could not be more wrong.

Vitter is a politician, not an evidence-based medical researcher, but he should know that the USPSTF process is perhaps the most transparent of any organization that publishes recommendations or guidelines. In fact, on the very website Vitter wants taken down, are html and pdf files of the complete recommendation, a supporting article, an evidence update article, an evidence synthesis and a clinical summary.

Government should be so transparent. USPSTF is widely praised for how completely it documents how it arrives at the recommendations it makes.

Strike one, Senator.

He says the recommendations were made “without input from those with experience and expertise in the field.” Has he checked the qualifications of the USPSTF members? Is he making the ridiculous claim that only an oncologist or a radiologist can judge evidence?

Strike two, Senator.

He claims that the recommendations were made “without due regard for the thousands of lives that could be impacted by the recommendation.” Is that why the punch line of the published recommendations reads: “The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient’s values regarding specific benefits and harms.”? Where is the lack of regard for the individual in that statement?

Strike three, Senator.

As he heads back to the dugout to dream up more rhetoric, he may want to stop over at the meeting of the National Breast Cancer Coalition which meets in DC this weekend. That smart bunch of evidence-based breast cancer advocates doesn’t agree with him at all. On their website they state:

NBCC continues to conclude that there is no statistically significant evidence that screening women age 40-49 years reduces mortality, and no strong evidence that it does so in women over 50 years.

Women need honest information regarding the value of all medical interventions. Public health resources need to be used with certainty to improve the public’s health. The reality is that screening has not been effective. While the incidence of ductal carcinoma in situ and localized invasive breast cancer increased substantially as a result of screening programs, the incidence of regional or distant stage disease declined only slightly. There may be several reasons for this, but primarily it is because screening increases the detection of non-threatening cancers, while missing the most aggressive cancers.

NBCC continues to affirm the position we have taken for over a decade. Women should make a personal decision about whether to undergo screening mammography after weighing the risks and benefits.

But maybe Senator Vitter thinks these women don’t know anything about breast cancer, either.

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Comments

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Alan

May 18, 2010 at 8:36 am

And my guess is Sebelius will happily throw USPSTF under the bus for her own political self-interest given her previous comments.

Greg Pawelski

May 18, 2010 at 9:41 am

Dr. Herman Kattlove, a retired medical oncologist did research on mammograms in the early 1990’s. Until his retirement in 2006, Kattlove had served as a medical editor for the American Cancer Society where he had helped develop much of the information about specific cancers that is posted on the society’s website.
He had written on his personal blog that the news about mammograms is not brand new information based on one study that just came out. The recommendations that the US Preventive Services Task Force (USPSTF) released is based on research that experts have known about for some time. He applauded the USPSTF for bringing this research to our attention.
He only wish that they done this three or four years ago. From a political point of view, the timing is unfortunate because it can used as fodder for those who opposed the health care reform legislation and will exploit this report to suggest that, under reform, the Government will use comparative effectiveness research (CER) to deny necessary care.
Few Congressmen are either M.D.’s or scientists trained to analyze and critique medical research. But this illustrates just how politically charged the question of diagnostic testing has become, especially when companies like GE that are making large profits on the sale of diagnostic testing equipment, and their lobbyists are helping to finance Congressional campaigns.

Paul Scott

May 19, 2010 at 10:21 am

I’m pretty sure that Amy Klobuchar is not much better on this.

Joseph Arpaia, MD

May 19, 2010 at 10:43 am

Medicine is no longer about health. It is about profit. And therefore recommendations from political pigs gorging themselves at lobbyists troughs are going to make statements that support interventions that make profit.

Wendy

May 20, 2010 at 8:39 am

Wouldn’t including radiologists (those who read mammograms and get paid for doing so) on the panel been a conflict of interest?

Alan

May 21, 2010 at 11:58 am

You can read more about the USPSTF here: http://www.ahrq.gov/clinic/uspstfab.htm.
It is a group of primary care physicians, often with expertise in epidemiology, outcomes research, etc., who weigh the evidence on risks, benefits, outcomes on behalf of other primary care physicians: “The USPSTF recommendation statements present health care providers with information about the evidence behind each recommendation, allowing clinicians to make informed decisions about implementation.”
As Gary notes, anyone who wants can go online and read all the evidence the USPSTF evaluated and the reasons for their recommendations. I think it is a fair bet that most of the people sounding off on the USPSTF haven’t bothered to read the statements or the evidence or have totally disregard for such things given that most of the gripes involve sound bites and bs rather than reasoned arguments and evidence. If the media were doing their job properly they, like Gary–would be reading the statements and evidence and calling pols and others to account for misrepresentation and pandering.