National Minority AIDS Council Building Healthier Communities

November 23, 2009

 

From the U.S. Preventive Services Task Force

 

November 18, 2009

 

This week, the U.S. Preventive Services Task Force (USPSTF) released their update of the 2002 breast cancer screening recommendations. In developing these recommendations, the USPSTF examined research on the efficacy of types of screening and their impact on reducing breast cancer deaths. In doing so, they commissioned and heavily weighed the updated recommendations on two studies which: 1) reviewed six selected questions about the harms and benefits of screenings; and 2) compared different screening models with expected health outcomes, associated costs and screening intervals.

 

“When I heard that these recommendations were being updated, I was very hopeful that the USPSTF would pay particular attention to the substantial body of research documenting racial and ethnic disparities in breast cancer incidence and death that have been published since the screening recommendations were last developed,” admitted Congresswoman Donna Christensen, Chair of the Congressional Black Caucus Health Braintrust. “However, in reviewing the USPSTF recommendation statement and its supporting documents, I am saddened and deeply concerned that they chose to develop recommendations that not only ignore the unique, disproportionate and detrimental impact that breast cancer has on African-American women, but that will likely have a devastating impact on African-American women.”

 

Among the revised recommendations included one against routine mammography screening in women aged 40 to 49 years because the USPSTF analyses found that despite the evidence proving that mammograms play a crucial life-saving role in the fight against breast cancer, the benefit to women in their 40s was virtually the same as the benefit to women in their 50s. Additionally, the USPSTF also now recommends that women aged 50 to 74 years have a mammogram once every two years.

 

These recommendations were made, despite a March 2009 study in Breast Cancer Research which found that African-American women – regardless of age or body weight – have a threefold greater risk of developing a particularly aggressive type of breast cancer that does not respond favorably to treatment. Additionally, these recommendation were made even with the findings from a November 2008 study published in the Journal of the National Cancer Institute which found that African-American women under the age of 40 have a higher risk of breast cancer than do white women of a similar age. This same report found that this disparity was highest among women under the age of 30 – with Black women having a 52 percent higher breast cancer incidence than white women. And, finally, these recommendations were made following the June 2006 study funded by the National Cancer Institute and printed in the Journal of the American Medical Association which found that while the incidence of breast cancer in premenopausal African-American women is lower than in their white counterparts, they are more likely to die from the disease.

 

“These are but three of the many sound and recent studies that confirm that when it comes to breast cancer, one size does not necessarily fit all because this disease affects subpopulations of women very differently,” observed the Congresswoman. “Unfortunately, the USPSTF did not consider these types of studies while updating the recommendations. In fact, in the USPSTF’s review of the evidence, the only time that research focusing on breast cancer disparities between African-American and white women is cited is in the appendix which lists all excluded studies. Adding insult to injury is the fact that despite the evidence, in one of the reports commissioned by USPSTF, there is an admission that the study ‘fails to capture differences in outcomes among certain risk subgroups’ and specifically lists ‘black women who seem to have more disease at young ages than white women’ as one such group,” continued Congresswoman Christensen, a physician who practiced for more than two decades before coming to Congress.

 

These recommendations are especially troubling during this historic time of health care reform. In both the House and Senate health care reform bills, there are aggressive provisions to ensure coverage of preventive services as components of the basic benefits package that will be offered by all health insurance plans. And, in determining which preventive services should be covered, the bills rely heavily on the USPSTF recommendations. Therefore, while the USPSTF does not determine federal policy, these recommendations could be used to determine the policies that private health insurance companies establish as they create afford health care plans that will be included in the forthcoming Exchange.

 

“This ultimately could serve as an insurmountable access barrier preventing women at high risk for the most aggressive forms of breast cancer from receiving the screenings that help detect breast cancer in its earliest stages,” observed Congresswoman Christensen. “It is perplexing and unfortunate that while the updated recommendations are supposed to move all women forward in the fight against breast cancer, the frightening reality is that they take African-American women a step backward.”