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New Mammography Guidelines Would Have Implications For Health Care Bill

The US Preventive Services Task Force, which previously recommended that women get screened for breast cancer at age 40, have changed their recommendation:

The new recommendations, which do not apply to a small group of women with unusual risk factors for breast cancer, reverse longstanding guidelines and are aimed at reducing harm from overtreatment, the group says. It also says women age 50 to 74 should have mammograms less frequently — every two years, rather than every year. And it said doctors should stop teaching women to examine their breasts on a regular basis.

Just seven years ago, the same group, the United States Preventive Services Task Force, with different members, recommended that women have mammograms every one to two years starting at age 40. It found too little evidence to take a stand on breast self-examinations.

The USPSTF cited the risks of overscreening and overtreatment, which are greater for women in their 40s.

In a normal circumstance, this would be a controversial study, and the American Cancer Society has already rejected the findings. In the context of health care reform, it’s far more controversial, beause the USPSTF is the baseline standard in the House health care bill, particularly for cost-sharing.

As I noted over the weekend, the House health care bill uses the recommendations of the USPSTF, known in the bill as the Task Force on Clinical Preventive Services, in determining coverage under the “minimum benefits package” required for all health plans. The Secretary of Health and Human Services can choose to go beyond those guidelines for coverage in the implementation stage; however, the USPSTF recommendations do come into play when it comes to cost sharing:

However, Sonfield does agree that the definition of what is exempt from cost sharing is too narrow in the House bill, precisely because of some of the limitations of the USPFTF’s studies. “There is no good rule of thumb for all this, so the House used that task force,” Sonfield said. “It’s not sufficient.” The Senate HELP Committee did pass an amendment, put forward by Sen. Barbara Mikulski (D-MD), that expanded the number of women’s health services that would be exempt from cost sharing. Sonfield prefers that option, and hopes it will live in the merged Senate bill and come out of conference. Obviously reducing costs expands access, particularly for low-income women, and so cost sharing can be as much a barrier as coverage in some respects.

So the final answer is that the picture is mixed – women’s health services are likely to be included in the minimum benefits package, but it will take some work from women’s health advocates and the public to ensure that they get the same treatment with respect to cost sharing in the final bill.

If the House version prevails in the final bill, it’s likely that women who opt for breast cancer screening at age 40, or who seek a mammography every year as opposed to every two years, would have to spend a good deal of money in co-pays for the service. And there’s at least a chance it wouldn’t be covered at all in those cases.

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David Dayen

David Dayen