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
Chicago 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.
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.