Debate over mammograms splits along party lines

WASHINGTON (Reuters) - Republicans argued on Wednesday that recommendations advising against routine mammograms for women in their 40s could be used to ration healthcare under reform legislation before Congress, a charge Democrats denied.

A radiologist examines breast X-rays after a cancer prevention medical check-up at the Ambroise Pare hospital in Marseille, southern France, on April 3, 2008. REUTERS/Jean-Paul Pelissier

The guidelines, issued on November 16 by the U.S. Preventive Services Task Force, a federal scientific advisory panel, said women in their 40s with an average risk for breast cancer did not need annual mammograms to screen for the disease.

The guidelines touched off a debate among cancer doctors.

Many groups, including the American Cancer Society, said they would stick by their current recommendation to start annual mammogram screening at age 40 because the breast X-rays have been proven to save lives by spotting tumors early on when they are most easily treated.

During a congressional hearing, Republican Representative Joe Barton argued that under Democratic healthcare reform legislation passed by the House of Representatives, the task force could determine what preventive services, including mammograms, would be covered for many Americans.

“To have a task force make the recommendation that has been made, and to have in this bill the authority that’s given to various unelected bureaucrats to make healthcare decisions, including coverage frequency, in my opinion, is wrong,” Barton told the House Energy and Commerce Committee’s subcommittee on health.

The Senate is debating its version of healthcare reform legislation, President Barack Obama’s top domestic priority.


“We don’t want rationing of healthcare in America. We don’t want to intervene between the doctor-patient relationship. We don’t want young women, or for that matter, more mature women over the age of 74, developing breast cancer because they’re not allowed a mammogram,” Barton said.

Democratic lawmakers dismissed the Republican concerns and said if healthcare reform legislation is not passed, many women would die from breast cancer because they lack any health insurance and do not get any preventive care.

“Nothing in this legislation prohibits insurance companies from covering mammograms,” Democratic Representative Zack Space told the panel.

“This bill makes preventive care a basic and fundamental right for every American,” he said.

Democratic Representative John Sarbanes said, “To me, the discussion today is not about rationing. It’s about being rational, about looking at all the evidence that is available to us and making a smart decision about what the coverage should be. I think the jury is out.”

The task force’s recommendations, which are based on computer models, attempted to balance the benefits of detecting breast cancer early with the potential harms of tests, treatments and worry to women who get false positive results.

Dr. Ned Calonge, chairman of the task force that issued the recommendations, said the timing of the guidelines, landing in the middle of the heated congressional healthcare reform debate, was unfortunate. Calonge admitted the guidelines were communicated poorly.

“Politics play no part in our processes. Cost and cost effectiveness were never considered in our discussions. We voted on these breast cancer screening recommendations in June of 2008, long before the last presidential election and any serious discussion of national health reform,” Calonge said.

An expert panel at the Radiological Society of North America meeting in Chicago disputed the recommendations, citing studies showing mammography of women in their 40s saves lives.

“About 20 percent of all breast cancer deaths in our country occur in women in their 40s,” said Dr. Stephen Feig of the University of California Irvine School of Medicine.

“What is the net effect (of the guidelines)? Screening will begin too late and it will be too little. It will save money, but we will lose lives.”

Reporting and writing by Julie Steenhuysen in Chicago; Editing by Maggie Fox and Alan Elsner