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New Mammography Guidelines Jolt Medical Field

Doctors Predict By-product of Screening Debate: More Talk With Patients About Mammograms

No Changes in Insurance Coverage

With health care reform percolating in the background, the mammography discussion immediately shifted to how the new advice would affect insurance coverage.

The leading health insurance trade group says insurers would maintain the status quo on mammograms. “Our interpretation is that women should be talking to their doctors, and if their doctor orders the test, then it would be covered,’’ says Susan Pisano, a spokeswoman for America’s Health Insurance Plans. “We’ve advocated for women to get screened. That hasn’t changed. Doctors and patients should be talking about benefits and harms.’’

Secretary of Health and Human Services Department Kathleen Sebelius admits the recommendations "caused a great deal of confusion and worry among women and their families," and emphasizes that the department's policies remain unchanged.

Women who are currently getting mammograms under Medicare will continue to be able to get them, says a spokesman for the Centers for Medicare and Medicaid Services. Medicare is the federal health insurance program for people 65 and older and the disabled.

How the new guidelines will affect private employer coverage is unclear, according to benefits consulting firm Mercer. “It is too soon to tell," says Mercer spokeswoman Stephanie Poe, adding that there is "too much conflicting advice" for employers to know if or how they would change their benefits plans.

Guidelines Often Change

The task force advice, meanwhile, offers an example of how the practice of medicine is not set in stone, doctors say.  

Much of medicine "is a work in progress," says Peter McGough, MD, a family physician who practices in a Seattle outpatient clinic connected with University of Washington Medicine. Doctors, he says, "are always thrilled when the guidelines are well established and clear."

McGough likens the mammogram debate to disagreements over guidelines for prostate cancer screenings. “We’ve always had to discuss it with patients - the benefits and risks - having them working with us to make the call."

He says he already has changed his practice on breast self-examination because recent scientific evidence shows it does not increase early detections.

“A couple of years ago, I stopped reinforcing it," he says.

Still, he notes it’s a highly emotional topic. “My opinion is that breast cancer, for women, is close to being No. 1 among their health concerns," McGough says.

Talk to Your Doctor

Stubbs says the task force guidelines are not much different from those created by the American College of Physicians two years ago. Doctors now will "be entering into more discussions with their patients," he says, and will focus more on treating them as individuals.

Tom Bader, MD, chief of general obstetrics and gynecology at the University of Pennsylvania, says the task force advice may change some doctors' practices, but not his.  

Meanwhile, Judi Chervenak, MD, an ob-gyn and associate clinical professor at Montefiore Medical Center in New York, defends current ACOG recommendations for routine mammography for women in their 40s.

“Catching something early may mean a woman may not need as aggressive a therapy," she says. “If we have a modality that can pick up the disease early, why can’t women have it?"

The risk of false-positives that the task force points out, Chervenak says, "is insulting to a woman’s intelligence."

“It’s assuming that women can’t take the news that they have a false-positive,’’ she says. “Women know there can be a false-positive."

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