0
Letters |

Comments and Response on the USPSTF Recommendation on Screening for Breast Cancer FREE

Anita Ho, PhD
[+] Article and Author Information

From University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada.


Acknowledgment: The author thanks Dave Unger, MD, and Suze Berkhout for their critical and constructive comments on an earlier draft.

Potential Conflicts of Interest: None disclosed.


Ann Intern Med. 2010;152(8):542-543. doi:10.7326/0003-4819-152-8-201004200-00207
Text Size: A A A

TO THE EDITOR:

The USPSTF (1), regarded by many medical professionals as a premier source of information on preventive services (2), was blind-sided by the recent controversy regarding its recommendation against routine screening mammography for asymptomatic women younger than 50 years. Although the evidence-based panel prides itself on being independent of advocacy groups or managed care organizations, the controversy can be better understood if we consider the sociopolitical context of women's health and health care reform. Historically, women have had substantially less access to some of the major diagnostic and therapeutic interventions than men (3), were more likely to delay or forgo necessary medical care, and expressed more concerns about the quality of health care they received (4). The panel's recommendations may have prompted many to perceive, correctly or incorrectly, that the guidelines were a setback in the promotion of women's health.

In the midst of discussions on health care reform, the public's response may also reflect its skepticism of scientists' claim of value neutrality in evidence-based medicine and their social authority based therein. After all, even if scientific evidence is the most important factor in the panel's recommendation, choosing which conditions create a large enough burden of suffering on society to warrant the USPSTF's investigation is partly a value judgment (5). Because the USPSTF's ratings influence insurance coverage of various preventive services, the public's flat-out rejection of the panel's conclusion may be a result of its distrust in the social authority of expert opinion, confusion about the panel's decision-making process, and concern about how rationing and funding priorities are determined by these experts.

In responding to accusations that its recommendations were politically and economically driven, the USPSTF adamantly denied any financial considerations. Instead of convincing the public of its neutral stance, the USPSTF may have inadvertently perpetuated the impression that financial considerations in health care are never legitimate. As the country continues its debate on health care reform, the USPSTF and government officials may want to use this controversy as a new opportunity to facilitate more informed and responsible discussions among citizens regarding the planning and funding of health care programs. Rather than simply denying that economic or social context plays any role in scientific review, it may be more useful for the USPSTF to clearly explain what values were part of the consideration, how such values were chosen, and why such values were appropriate in determining its guidelines.

Anita Ho, PhD

University of British Columbia

Vancouver, British Columbia V6T 1Z4, Canada

References

U.S. Preventive Services Task Force.  Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2009; 151. PubMed
 
Eisenberg JM, Kamerow DB.  The Agency for Healthcare Research and Quality and the U.S. Preventive Services Task Force: public support for translating evidence into prevention practice and policy. Am J Prev Med. 2001; 20:1-2. PubMed
CrossRef
 
Segev DL, Kucirka LM, Oberai PC, Parekh RS, Boulware LE, Powe NR, et al..  Age and comorbidities are effect modifiers of gender disparities in renal transplantation. J Am Soc Nephrol. 2009; 20:621-8. PubMed
 
Salganicoff A, Beckerman JZ, Wyn R, Ojeda V.  Women's Health in the United States: Health Coverage and Access to Care. Washington, DC: Henry J. Kaiser Family Foundation; 2002. Accessed atwww.kff.org/womenshealth/20020507a-index.cfmon 3 February 2010.
 
Harris RP, Helfand M, Woolf SH, Lohr KN, Mulrow CD, Teutsch SM, et al., Methods Work Group, Third US Preventive Services Task Force.  Current methods of the US Preventive Services Task Force: a review of the process. Am J Prev Med. 2001; 20:21-35. PubMed
 

Figures

Tables

References

U.S. Preventive Services Task Force.  Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2009; 151. PubMed
 
Eisenberg JM, Kamerow DB.  The Agency for Healthcare Research and Quality and the U.S. Preventive Services Task Force: public support for translating evidence into prevention practice and policy. Am J Prev Med. 2001; 20:1-2. PubMed
CrossRef
 
Segev DL, Kucirka LM, Oberai PC, Parekh RS, Boulware LE, Powe NR, et al..  Age and comorbidities are effect modifiers of gender disparities in renal transplantation. J Am Soc Nephrol. 2009; 20:621-8. PubMed
 
Salganicoff A, Beckerman JZ, Wyn R, Ojeda V.  Women's Health in the United States: Health Coverage and Access to Care. Washington, DC: Henry J. Kaiser Family Foundation; 2002. Accessed atwww.kff.org/womenshealth/20020507a-index.cfmon 3 February 2010.
 
Harris RP, Helfand M, Woolf SH, Lohr KN, Mulrow CD, Teutsch SM, et al., Methods Work Group, Third US Preventive Services Task Force.  Current methods of the US Preventive Services Task Force: a review of the process. Am J Prev Med. 2001; 20:21-35. PubMed
 

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Want to Subscribe?

Learn more about subscription options

Advertisement

Want to Subscribe?

Learn more about subscription options

Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)