U.S. Preventive Services Task Force
Encyclopedia
The U.S. Preventive Services Task Force (USPSTF) is "an independent panel of experts in primary care and prevention that systematically reviews the evidence of effectiveness
and develops recommendations for clinical preventive services." The task force, a panel of primary care physicians and epidemiologists, is funded, staffed, and appointed by the U.S. Department of Health and Human Services' Agency for Healthcare Research and Quality
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in the hope of detecting the disease in an early, easily treatable stage. The advice about using mammography in the presence of symptoms (such as a palpable lump in the breast) is unchanged.
The previous advice was for all women over the age of 40 to receive a mammogram every one to two years. The new advice is more detailed.
For women between the ages of 50 and 74, they have recommended routine mammograms once every two years in the absence of symptoms. Most American women who are diagnosed with breast cancer are diagnosed after age 60.
No recommendation is made about mammograms in women over the age of 75, as very little research has been performed in this age group.
The Task Force recommended against routine mammography
to screen asymptomatic women aged 40 to 49 years for breast cancer
. Patients in this age group should be educated about the risks and benefits of screening, and the decision whether to screen or not should be based on the individual situation and preferences. The old advice was based on "weak" evidence for this age group. The new advice is based on improved scientific evidence about the benefits and harms associated with mammography and is consistent with recommendations by the World Health Organization
and other major medical bodies. Their recommendation against routine, suspicion-less mammograms for younger women does not change the advice for screening women at above-average risk for developing breast cancer or for testing women who have a suspicious lump or any other symptoms that might be related to breast cancer.
The change in the recommendation for younger women has been criticized by some physicians and cancer advocacy groups, such as Otis Brawley, the chief medical officer for the American Cancer Society
, and praised by physicians and medical organizations that support individualized and evidence-based medicine
, such as Donna Sweet, the former chair of the American College of Physicians
, who currently serves on its Clinical Efficacy Assessment Subcommittee.
The USPSTF recommendation, which focuses solely on clinical effectiveness without regard to cost, formally reduces the grade given for evidence quality from "B" to "C" (limited evidence prevents a one-size-fits-all recommendation) for routine mammograms in women under the age of 50. With a grade C recommendation, physicians are required to consider additional factors, such as the individual woman's personal risk of breast cancer. Pending health care legislation would require insurance companies to cover any and all preventive services that receive an "A" or "B" grade, but permit them to use discretion on preventive services that receive a worse grade.
The Vitter amendment to pending legislation in the U.S. Senate instructs insurers to disregard the task force's recommendation against frequent routine mammograms in asymptomatic younger women, and requires them to provide free annual mammograms, even for low-risk women, based on the outdated 2002 report. This proposal is not yet law and may change. The efforts by politicians to reject the committee's scientific findings have been condemned as an example of unwarranted political interference in scientific research
.
Evidence-based medicine
Evidence-based medicine or evidence-based practice aims to apply the best available evidence gained from the scientific method to clinical decision making. It seeks to assess the strength of evidence of the risks and benefits of treatments and diagnostic tests...
and develops recommendations for clinical preventive services." The task force, a panel of primary care physicians and epidemiologists, is funded, staffed, and appointed by the U.S. Department of Health and Human Services' Agency for Healthcare Research and Quality
Agency for Healthcare Research and Quality
The Agency for Healthcare Research and Quality is a part of the United States Department of Health and Human Services, which supports research designed to improve the outcomes and quality of health care, reduce its costs, address patient safety and medical errors, and broaden access to effective...
.
Methods
The methods of evidence synthesis used by the Task Force have been described in detail. In 2007, their methods were revised.Mammography recommendations
In 2009, the USPSTF updated its advice for screening mammograms. Screening mammograms, or routine mammograms, are X-rays given to apparently healthy women with no symptoms or evidence of breast cancerBreast cancer
Breast cancer is cancer originating from breast tissue, most commonly from the inner lining of milk ducts or the lobules that supply the ducts with milk. Cancers originating from ducts are known as ductal carcinomas; those originating from lobules are known as lobular carcinomas...
in the hope of detecting the disease in an early, easily treatable stage. The advice about using mammography in the presence of symptoms (such as a palpable lump in the breast) is unchanged.
The previous advice was for all women over the age of 40 to receive a mammogram every one to two years. The new advice is more detailed.
For women between the ages of 50 and 74, they have recommended routine mammograms once every two years in the absence of symptoms. Most American women who are diagnosed with breast cancer are diagnosed after age 60.
No recommendation is made about mammograms in women over the age of 75, as very little research has been performed in this age group.
The Task Force recommended against routine mammography
Mammography
Mammography is the process of using low-energy-X-rays to examine the human breast and is used as a diagnostic and a screening tool....
to screen asymptomatic women aged 40 to 49 years for breast cancer
Breast cancer
Breast cancer is cancer originating from breast tissue, most commonly from the inner lining of milk ducts or the lobules that supply the ducts with milk. Cancers originating from ducts are known as ductal carcinomas; those originating from lobules are known as lobular carcinomas...
. Patients in this age group should be educated about the risks and benefits of screening, and the decision whether to screen or not should be based on the individual situation and preferences. The old advice was based on "weak" evidence for this age group. The new advice is based on improved scientific evidence about the benefits and harms associated with mammography and is consistent with recommendations by the World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
and other major medical bodies. Their recommendation against routine, suspicion-less mammograms for younger women does not change the advice for screening women at above-average risk for developing breast cancer or for testing women who have a suspicious lump or any other symptoms that might be related to breast cancer.
The change in the recommendation for younger women has been criticized by some physicians and cancer advocacy groups, such as Otis Brawley, the chief medical officer for the American Cancer Society
American Cancer Society
The American Cancer Society is the "nationwide community-based voluntary health organization" dedicated, in their own words, "to eliminating cancer as a major health problem by preventing cancer, saving lives, and diminishing suffering from cancer, through research, education, advocacy, and...
, and praised by physicians and medical organizations that support individualized and evidence-based medicine
Evidence-based medicine
Evidence-based medicine or evidence-based practice aims to apply the best available evidence gained from the scientific method to clinical decision making. It seeks to assess the strength of evidence of the risks and benefits of treatments and diagnostic tests...
, such as Donna Sweet, the former chair of the American College of Physicians
American College of Physicians
The American College of Physicians is a national organization of doctors of internal medicine —physicians who specialize in the prevention, detection, and treatment of illnesses in adults. With 130,000 members, ACP is the largest medical-specialty organization and second-largest physician group in...
, who currently serves on its Clinical Efficacy Assessment Subcommittee.
The USPSTF recommendation, which focuses solely on clinical effectiveness without regard to cost, formally reduces the grade given for evidence quality from "B" to "C" (limited evidence prevents a one-size-fits-all recommendation) for routine mammograms in women under the age of 50. With a grade C recommendation, physicians are required to consider additional factors, such as the individual woman's personal risk of breast cancer. Pending health care legislation would require insurance companies to cover any and all preventive services that receive an "A" or "B" grade, but permit them to use discretion on preventive services that receive a worse grade.
The Vitter amendment to pending legislation in the U.S. Senate instructs insurers to disregard the task force's recommendation against frequent routine mammograms in asymptomatic younger women, and requires them to provide free annual mammograms, even for low-risk women, based on the outdated 2002 report. This proposal is not yet law and may change. The efforts by politicians to reject the committee's scientific findings have been condemned as an example of unwarranted political interference in scientific research
Politicization of science
The politicization of science is the manipulation of science for political gain. It occurs when government, business, or advocacy groups use legal or economic pressure to influence the findings of scientific research or the way it is disseminated, reported or interpreted. The politicization of...
.