AMA House of Delegates

"Women and their physicians look to the AMA for clear guidance" on screening mammography, says Arl Van Moore, MD, a delegate for the American College of Radiology. Photo by Ted Grudzinski / AMA

Support given to mammography access for women older than 40

AMA delegates adopt policy that the decision about breast cancer screening should be between a woman and her physician.

By Victoria Stagg Elliott — Posted July 2, 2012

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In response to concerns that recent guideline changes may reduce insurance coverage of screening mammography, the American Medical Association adopted policy at its Annual Meeting stating that women past age 40 must be able to receive the procedure if they ask for it and their physician agrees. The patient's insurance should cover the procedure, the policy states.

“If a woman wants to receive a mammogram and the physician believes it is appropriate, she should be able to receive one,” said Lee R. Morisy, MD, chair of the Council on Science and Public Health that wrote the report on the subject and a general surgeon in Memphis, Tenn.

Previously, the AMA supported annual screening mammograms in asymptomatic women older than 40. That was in line with the 2002 recommendations from the U.S. Preventive Services Task Force stating that screening mammography should be done every one to two years in this age group.

The long-standing debate about which women should receive mammography and how often they should be screened reignited in November 2009 when the USPSTF revised its recommendations on the issue. The panel said the decision to start mammography before age 50 was an individual one, and that the procedure did not need to be done routinely in this age group. Women 50 to 75 were told to get mammograms every two years.

AP Images|unlim|frl|tuck|photo|200x265|

Dr. Morisy Photo by Peter Barreras / AP Images for American Medical News

Numerous studies have come to conflicting conclusions about the value of mammography in various age groups. The USPSTF cited evidence that the use of the screening test in women in their 50s and 60s is strong but is less compelling for those 40 to 49.

The new policy updates the AMA's position on the issue and emphasizes that the decision to screen is between a patient and her doctor.

“All patients are different and have varying degrees of cancer risk, and patients should regularly talk with their doctors to determine if mammography screening is right for them,” said Patrice A. Harris, MD, an Atlanta psychiatrist and member of the AMA Board of Trustees.

In related action, delegates adopted a policy expressing concern that the USPSTF mammography recommendations, along with those on the use of prostate-specific antigen to screen for prostate cancer, would limit access to preventive care. In May, the task force recommended against routinely performing the PSA test on all men.

The AMA policy states that the organization will encourage the USPSTF to implement procedures to allow for greater input from specialists when drafting prevention recommendations. The USPSTF currently posts drafts of potential guidelines for public comment, and disease experts are solicited as the guidelines are developed.

“Experts can and do provide input in the beginning, in the middle and at the end of the process,” said Marcel Salive, MD, MPH, speaking for the U.S. Public Health Service.

Attendees said this was not enough.

“We contacted the USPSTF to provide meaningful input, and none of our experts in the field were able to participate,” said Arl Van Moore, MD, a diagnostic radiologist from Charlotte, N.C., and delegate for the American College of Radiology, speaking for the college.

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Meeting notes: Public health

Issue: The popularity of social networking sites among adolescents and youths has created new opportunities for bullying, which can have serious social and mental health consequences for victims.

Proposed action: Urge social networking platforms to adopt terms of service that define and prohibit electronic aggression, which may include any type of harassment or bullying, including but not limited to that occurring through email, chat room, instant messaging, website or text messaging. [Adopted]

Issue: Actors smoking in movies can influence adolescents who see them smoking, and some of those youths ultimately will die of tobacco-related diseases.

Proposed action: Recommend that no tax incentives be given for motion picture productions that show people using tobacco products, nonpharmaceutical nicotine delivery devices or associated paraphernalia. An exception can be made for films that depict tobacco use of a historical person or that portray the dire health consequences of smoking. [Adopted]

Issue: The rate of suicide attempts is significantly higher among lesbian, gay, bisexual and transgender youths compared with the rest of the adolescent and teenage population.

Proposed action: Partner with organizations dedicated to public health and public policy to reduce suicide among LGBT and questioning youths, and improve the health of that population. [Adopted]

Issue: Excessive exposure to nighttime lighting can disrupt the circadian biological rhythms of sleep and create potentially harmful health effects. Such health effects could include an increased risk of developing cancer, diabetes and obesity.

Proposed action: Support the need for developing lighting technologies that minimize circadian disruption and encourage further research on the risks and benefits of occupational and environmental exposure to light at night. Adopted

Issue: Health care facilities are increasingly launching antibiotic stewardship programs to reduce the risk that bacteria will develop drug resistance.

Proposed action: Support these programs when supervised by qualified physicians as an effective way to ensure that antibiotic use is appropriate. [Adopted]

Issue: Bioengineered foods have generated a great deal of debate. Some say they are safe. Others say there are not enough data about their impact on human health or the environment to reach that conclusion.

Proposed action: Support mandatory pre-market systematic safety assessments of bioengineered foods and continued research into possible environmental consequences of farming them. [Adopted]

Issue: The James Zadroga 9/11 Health and Compensation Act of 2010 established a program to provide health services for medical conditions related to the terrorist attack on New York's World Trade Center among first responders. Cancer was not on the list of covered health issues, but some research indicates that this group of people is at higher risk.

Proposed action:Encourage further study of the link between cancer and exposure to the detritus from the World Trade Center attacks of Sept. 11, 2001. [Adopted]

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