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Can The Mammogram Panel Read A Mammogram?

This article is more than 9 years old.

Soon the U.S. Preventive Services Task Force (USPSTF) will issue a new draft of recommendations for breast cancer screening in women. As outlined on its website, the AHRQ-appointed panel aims to “improve the health of all Americans by making evidence-based recommendations about clinical preventive services such as screenings, counseling services, and preventive medications.”

When the panel last published a draft of new breast cancer screening guidelines in November 2009, an uproar followed. The key USPSTF changes, published in the Annals of Internal Medicine, included a recommendation against routine screening mammography for women aged 40 to 49 years. For women between the ages of 50 and 74, biennial screening was advised.

So who are the current USPSTF panel members who will issue the new breast cancer screening recommendations? The roster lists 16 individuals. It includes 13 physicians (MDs), 2 nurses (RNs) and one clinical psychologist.

The two co-chairs, Drs. Michael LeFevre and Albert Siu, are both accomplished physicians who hold MSPH (Master of Science in Public Health) degrees. LeFevre, a member of the Institute of Medicine, is a practitioner of family medicine and professor in the Department of Family and Community Medicine at the University of Missouri. Siu is a geriatrician and professor who chairs the Department of Geriatrics and Palliative Medicine at New York’s Icahn School of Medicine at Mount Sinai.

It’s a bit like a jury of health care professionals who weigh the evidence on breast cancer screening. Among the 16 USPSTF members, 10 hold advanced degrees in public health (MPH). Several more have master degrees in fields having to do with statistics and clinical research methods.

Among the 13 physicians on the task force, the areas of expertise by clinical training include internal medicine (5), family practice (4), obstetrics and gynecology (2), pediatrics (1) and combined training in internal medicine and pediatrics (1). The USPSTF does not include an oncologist, a radiologist, a cancer surgeon, a pathologist or radiation oncologist – specialists who are typically involved in the diagnosis and care of women with breast cancer.

Some people say that clinical expertise shouldn’t matter in evaluating published results of trials and meta-analyses. But I think that at least one oncologist (or, better, a handful in a panel of 16 for breast cancer screening guidelines) and radiologist would offer insight – if not the last word – on the potential benefits, physical harms and costs of breast cancer screening by old-fashioned, digital or 3-D mammography, sonography, MRI and breast self-examination. Perhaps one of those specialists might point out and persuade the larger group of problems and limits to published evidence. An expert might notice something – a flaw in a study or benefit, untallied, that the other panelists don’t realize or fully appreciate.

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