February 2016

Editor's Note: Eye of the Beholder?
By Jim Knaub
Radiology Today
Vol. 17 No. 2 P. 3

When should a woman begin having mammograms and how often should she have them?

Congress got it right by letting a woman decide and requiring her health insurance to cover it—at least until the end of 2017, as language from the so-called PALS (Protecting Access to Lifesaving Screenings) Act (HR 3339/S 1926) was included in the Consolidated Appropriations Act of 2016. The law effectively blocks insurers from using the recommendation of the United States Preventive Service Task Force (USPSTF) as a justification not to cover mammography. To be sure, Congress knows a thing or two about kicking a can down the road, but in this case doing so seems perfectly reasonable.

In January, USPSTF essentially doubled down on its 2009 recommendation that women at average risk for breast cancer can safely begin mammograms at age 50 and have them every other year through age 74.

Advocacy groups favoring annual screening beginning at age 40 for women at normal risk for breast cancer reprised their opposition to those recommendations. They use their data interpretation to point out the risk that trimming screening could have on women's lives.

It comes down to how the potential harms of overtreatment and the anxiety of false positives are weighed against the small increase in cancers found. Which is the right view? With mammogram coverage in place, let each woman decide. The concerns surrounding false positives and potentially unnecessary treatment may seem more threatening than a slightly increased risk of not catching a cancer sooner. Another woman might gladly accept the anxiety and potential overtreatment to modestly reduce her cancer risk.

Interestingly, the USPSTF has pretty much fallen in line with that view, according to a New York Times article on the topic: "The task force emphasized that it was not advising against screening for women under 50 or over 74, or against screening every year as opposed to every other year," wrote the Times' Denise Grady. "Rather, it says that women should choose for themselves—but that its guidelines offer the best overall balance of benefits and risks."

Apparently, at least sometimes, benefits and risks are in the eye of the beholder.
Enjoy the issue.