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Spokane, Washington  Est. May 19, 1883

Sebelius urges individual choices on mammograms

Recommended changes don’t reflect U.S. policy, health secretary says

Rob Stein And Dan Eggen Washington Post

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, in a written statement, 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 to address one of the most explosive issues in women’s health.

The task force Monday recommended that women in their 40s stop having routine mammograms and instead individually discuss whether to get the exams with their doctors. The panel 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 harm caused by false alarms.

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 in the statement. “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. Even as some Republicans were raising the specter of health care rationing Wednesday morning, White House officials were distancing the administration from the panel’s decision. Wednesday afternoon, Sebelius expressed that view forcefully, though officials said her statements were more a disagreement with the science than part of the political pushback.

In an interview, 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.”

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, in an interview.

James Thrall of the American College of Radiology, which condemned the guidelines, praised Sebelius’ statement but called on the secretary to order the task force to rescind its recommendations “in order to avoid confusion as health care reform moves forward.”