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No change on mammography policy for government programs, Sebelius says

WASHINGTON — A top federal health official said Wednesday that the controversial new guidelines for breast cancer screening do not represent government policy, as the Obama administration sought to keep the debate over mammograms from undermining the prospects for health care reform.

Health and Human Services Secretary Kathleen Sebelius said the new guidelines had "caused a great deal of confusion and worry among women and their families across this country," and she stressed that they were issued by "an outside independent panel of doctors and scientists who ... do not set federal policy and ... don't determine what services are covered by the federal government."

Sebelius' statement challenged the recommendations of that influential panel, the U.S. Preventive Services Task Force, made up of independent experts assembled by her department who said most women should not start routine mammograms until they are 50, as opposed to the current standard of 40. She said government insurance programs would continue to cover routine mammograms for women starting at age 40.

The Medicare program, which primarily covers those 65 or older but also insures younger people with disabilities, currently pays for annual mammograms starting at age 40. Coverage policies for Medicaid, the shared state and federal health insurance program for low-income people, are set by the states.

The task force also recommended that women in their 50s get mammograms routinely every two years, instead of annually. The panel argued that the benefits of more frequent exams were outweighed by the harms caused by false alarms, which can lead to anxiety and sometimes unneeded treatment.

While hailed by many patient advocates and breast cancer experts, the new guidelines have been harshly criticized by the American Cancer Society, the American College of Radiology and others, including some members of Congress. Some have questioned whether the guidelines are related to the health care reform debate and efforts to save money by rationing care — allegations strongly denied by the task force.

"The task force has presented some new evidence for consideration but our policies remain unchanged," Sebelius said. "Indeed, I would be very surprised if any private insurance company changed its mammography coverage decisions as a result of this action."

She added: "My message to women is simple. 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."

Worried that the guidelines might complicate the health care debate, reaction to the panel's decision inside the White House was swift. By Tuesday night, the rationing argument had already made it to Fox News, prompting a quick response on an administration blog.

White House spokesman Dan Pfeiffer said that "this would be a provably false and entirely disingenuous attack, but that hasn't stopped the opponents of health reform to date."

But it was not just Republicans who expressed dismay. Rep. Debbie Wasserman Schultz, D-Fla., who voted for the health overhaul bill in the House, said she was "very concerned" that the recommendations conflict with those of other authorities, like the American Cancer Society."

"At a time when we are working to reform our health care system to provide greater access to preventative care," Wasserman Schultz said, "these guidelines and the fact that they conflict with many of the recommendations from leading cancer organizations only adds to the confusion."

In an interview Wednesday on CNN, Sebelius said that the task force members "do not make policy decisions. They don't make coverage decisions. And that's really the critical piece."

Under health care reform legislation pending in Congress, the task force's recommendations would be used to help determine the basic coverage that insurance companies would need to offer for preventive services. But task force officials said that played no role in the panel's decision and costs were never considered. In fact, the task force decided to review the mammography guidelines and completed the bulk of its work on the issue years before the presidential election and the reform push, said Ned Calonge, the task force's chairman.

Supporters of the new guidelines said they were deeply disappointed by the move, especially coming from an administration that has said its decisions would be driven by science and not politics.

"This should not be an issue of political pressure or public pressure," said Fran Visco, president of the National Breast Cancer Coalition, which supports the task force's findings. "It should be an issue of what the science says and what's best for women. We're not rationing care; we're doing what's best for the health of women."

A group of female GOP lawmakers attacked the task force's recommendations during a news conference Wednesday, arguing that the guidelines would deprive patients of needed care and that they provide a glimpse of the dangers of an increased government role in health care.

"This is how rationing begins. This is the little toe in the edge of the water," Rep. Marsha Blackburn, R-Tenn., said. "This is when you start getting a bureaucrat between you and your physician. This is what we have warned about."

The Washington Post and New York Times contributed to this report.

No change on mammography policy for government programs, Sebelius says 11/18/09 [Last modified: Thursday, November 19, 2009 8:34am]

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