U.S. Preventive Services Task Force Recommendations

In early January of 2016, the U.S. Preventative Services Task Force (USPSTF), a panel financed by the Department of Health and Human Services (HHS), again released their recommendations that most women do not need regular mammograms until they turn 50, in effect, continuing their overturning of previous recommendations suggesting women receive annual mammograms to check for breast cancer after 40.

Since regular mammography became standard practice in the early 1990s, mortality from breast cancer, the second leading cause of cancer death among American women, has dropped by about 30%, after remaining constant for the prior half-century. The 16-member task force ruled that patients under 50 or over 75 without special risk factors no longer need screening.

The task force concluded that one cancer death is prevented for every 1,904 women age 40 to 49 who are screened for 10 years, compared with one death for every 1,339 women age 50 to 59, and one death for every 377 women age 60 to 69.  Many women are still alive because they were tested early, roughly 15% of them because they received mammograms in their 40’s!

In response to these recommendations, the American Cancer Society said “The American Cancer Society continues to recommend annual screening using mammography and clinical breast examination for all women beginning at age 40. Our experts make this recommendation having reviewed virtually all the same data reviewed by the USPSTF, but also additional data that the USPSTF did not consider. When recommendations are based on judgments about the balance of risks and benefits, reasonable experts can look at the same data and reach different conclusions.”

In response to these recommendations, the American Cancer Society said “The updated USPSTF recommendation has once again confirmed the value of screening mammography, concluding that the benefit of mammography outweighs the harms of screening in all age groups from age 40 through ages 74. It emphasizes that women and clinicians providing primary care to women both need to understand the benefits and harms of screening."

Some questioned whether these new guidelines were designed more to control spending than to improve health. These recommendations may cause fewer doctors to recommend mammograms to their patients which will result in fewer women getting screened in their 40’s.  And although the state of New Jersey requires that insurance companies cover mammogram screenings, I fear that this move may prompt insurers in other states to deny coverage for this procedure.

It also has come to my attention that these guidelines are primarily based on Swedish, British and Canadian studies. According to the British government's Office of National Statistics, 82% of British women diagnosed with breast cancer survive and the Canadian Breast Cancer Foundation reports that 87% of Canadian women live compared to 98% of women in America according to the American Cancer Society reports.  These new recommendations, based largely on studies from countries with socialized health care systems, have confused and scared people who may fear our country's health care system is headed in that direction.

This decision to change long-time guidelines for breast cancer screening is causing great concern, and well it should. As a consequence, I wrote former Secretary of the Department of Health and Human Services Kathy Sebelius to request more information on how the USPSTF came to their conclusions.

Please know that I remain committed to preventing cancer and helping patients receive the highest level of care possible. I have been a long time supporter of breast cancer research, and  cosponsored the following legislation in the 114th Congress:

  • H.R. 3339, the Protecting Access to Lifesaving Screenings Act, to protect access to breast screening mammographies for women, ages 40 to 74.

Prostate Cancer Recommendations

In June of 2012, the USPSTF released their final recommendation regarding prostate specific antigen (PSA) testing.

The USPSTF has downgraded PSA testing to a “grade D recommendation”, which recommends against PSA screenings for prostate cancer in asymptomatic men, stating that there is moderate or high certainty that the service has no net benefit, or that the harms of the service will outweigh the benefits.

As you are aware, prostate cancer is the most commonly diagnosed non-skin cancer in men in the U.S., and 1 in 6 American men will develop prostate cancer in their lifetime. Early prostate cancer often has no symptoms and therefore it is vital that PSA testing, in combination with a digital rectal exam, be encouraged and used for all men, regardless of their symptom level.

I wrote to former Secretary of Health and Human Services, Kathleen Sebelius, twice to request an expanded explanation of the research the USPSTF used to reach this conclusion.  As a long time advocate for prostate cancer prevention, I am deeply concerned that this final recommendation will have a very real and very negative impact on men’s health and their families.