Senator strikes out by politicizing mammography recommendations

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.