Is it politically motivated?

Someone posted recently on another thread that the federal gov't is now distancing itself from the guidelines.  But as someone suggested, is it just "hot air"?

Edited to add:  Or are, gasp, they listening!!!  Let's hope.

ADK...The federal government is lying because this panel IS part of the US government!  If they want this panel to change their recommendations then they would tell them to do so!  Any "Study" can say anything you want it to say, you just need to pick and choose the "evidence" you want to use from the study to get what you want done.

Don't believe me?  Here is their website and then tell me if you think it is the government?

http://www.ahrq.gov/CLINIC/uspstfix.htm 

AHRQ sits over the Preventive Task Force in the hierarchy. No way to get around that if you follow the trail. Surprised MSM hasn't seized on this. Here are two good links which demonstrate this on AHRQ:

http://www.ahrq.gov/about/whatis.htm

http://www.ahrq.gov

HHS Sebelius and the WH is indeed trying to distant themselves from this Task Force's recent publication. But behind the scenes there are undoubtely sharp words to ahrq that this was even approved for production. Or, if you're a conspiracy nut, are there? Is there a bigger picture some are not privy too. Drawing from my own life experience, timing is everything, and nothing is unplanned. 

Ahrq had the ultimate decision making power whether to release this task force's recommendations now, or (shocking) send it out for peer review including to oncologists and breast surgeons. 

Oops,

Tender

It was the original two studies on which the Task Force reached their conclusions which were peer-reviewed in the Annals of Internal Medicine, not the subsequent Guidelines themselves written by the Task Force. Curious too on journal selection for peer review of the original studies. Why the Annals of Medicine for mammogram guidelines rather than the re-known Journal of American Society of Clinical Onocolgy? Perhaps because the inital study data would have been analyzed differently by expert peer oncologists? 

"The USPSTF guidelines were updated using evidence from two studies commissioned by the task force and reported in the same issue of the Annals of Internal Medicine. One study, funded by the Agency for Healthcare Research and Quality, is an updated systematic review of screening mammography randomized, controlled trials (Ann. Intern. Med. 2009;151:727-37). It concludes that mammography screening reduces breast cancer mortality by 15% for women aged 39-69 years, and that both false-positive results and additional imaging are common. Among the studies reviewed, "rates of overdiagnosis vary from less than 1% to 30%, with most from 1% to 10%," noted investigator Dr. Heidi Nelson of Oregon Health and Science University, Portland.

The other study, by the Cancer Intervention and Surveillance Modeling Network (CISNET) that was funded by the National Cancer Institute, used estimates of screening outcomes for a range of screening strategies at different frequencies and ages of initiation and cessation (Ann. Intern. Med. 2009;151:738-47). This study concluded that "biennial intervals are more efficient and provide a better balance of benefits and harms than annual intervals." Three potential screening harms were examined: false-positive mammograms, unnecessary biopsies, and overdiagnosis. "

But, the American Cancer Society, which has been at the center of a recent "media firestorm" over rumors of a similar softening on breast and prostate cancer screening, was quick to distance itself from the new USPSTF recommendation.

"The American Cancer Society continues to recommend annual screening using mammography and clinical breast examination for all women beginning at age 40," ACS Chief Medical Officer Otis W. Brawley said in a written statement. "Our experts make this recommendation having reviewed virtually all the same data reviewed by the USPSTF, but also additional data that the USPSTF did not consider. When recommendations are based on judgments about the balance of risks and benefits, reasonable experts can look at the same data and reach different conclusions."

http://www.oncologystat.com  (regrettably, password protected site,i.e.,must register)

Here too:

Retraction urged

"James H. Thrall of the American College of Radiology, which condemned the guidelines, praised Sebelius's statement but called on the secretary to order the task force to rescind its recommendations "to avoid confusion as health-care reform moves forward."

Thrall also urged Sebelius to make sure the panel included "experts from the areas on which they will be advising lawmakers and submit their recommendations for comment and review to outside stakeholders in similar fashion to rules enacted by the Centers for Medicare and Medicaid Services. A more inclusive process can only benefit Americans as we seek to improve our health care system."

Sebelius pointed out in the CNN interview that the task force was appointed by the Bush administration. Calonge said the members were selected independently with no political interference"

 www.washingtonpost.com on 11-18-09

I agree Madalyn. I mainly highlighted Dr. Thrall's words because I read them this morning and found the calling for oncologists, breast surgeons and yes, even radiologists to the table to be an issue I agreed with.

Radiologists must have a very difficult time seeing through glass prisms on this issue.

Hi Tender,

I would have thought that the guidelines were peer-reviewed as well, as they are published in the same issue of Annals, as a group with the other two papers, under the "peer-reviewed" section of the Table of Contents.

U.S. Preventive Services Task Force. Screening for Breast Cancer: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med November 17, 2009 151:716-726.

But perhaps not.

I totally agree that I think it's crazy that these primary care types were charged with issuing these guidelines -- and because they're primary care types, "Annals" is where these types choose to publish.

I swear, I wonder if Susan Love was a peer-reviewer!  Seeing as she's so vigorously supporting the new guidelines!

Hi Ann,

It is odd the way the Taskforce is under AHRQ, yet publishes the Guidelines in the Annals of Internal Medicine. Thank you for looking into reimbursement of the sitting panal: I'm particularly curious about the Chairman's relationship with any health insurance company and whether this is a conflict of interest. It would seem difficult to wear two different hats, especially when health insurers have the bottom line of their business to see meet.

If the AHRQ, as per it's mission statements of best evidence clarification, continues on with these Taskforce Guidelines, why not submit them for publication in the Journal of the National Institutes of Health. But perhaps that's too blatant a connection?  Like all others, I firmly stand on transparency with this government issue (NIH grant supported, Task Force oversight and Per Diem's etc) and the far reaching effect of production of independent mammogram guidelines. 

Not to push too far here, but as any legal scholar will tell you, Disclaimers are only as good as the people writing them and their circumstances. 

The Agency for Healthcare Research and Quality's (AHRQ) mission is to improve the quality, safety, efficiency, and effectiveness of health care for all Americans. Information from AHRQ's research helps people make more informed decisions and improve the quality of health care services. AHRQ was formerly known as the Agency for Health Care Policy and Research.

Disclaimer: Recommendations made by the USPSTF are independent. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services

I don't see how there's not a conflict of interest here in spite of the AHRQ disclaimer. AHRQ is looking for efficient, informed quidelines, and USPSTF provided them. Curiously, the USPSTF mammogram guidelines are more "limiting" in their effect: limiting in medical provision to 50 year olds and then every other year, limiting in cost by reduced mammograms to society (but) limiting in safety to the 3% of patients whose missed cancers are considered acceptable from a societal (not individual view, or are they?). Except for the safety issue surrounding the 3% missed, this in line with AHRQ's mission of efficiency: ef·fi·cient: productive of desired effects; especially : productive without waste (Sorry 3%).

http://www.merriam-webster.com/dictionary/efficient

Perhaps the AHRQ might recognized a slight forked tongue situation here, and completely separate the USPSTF from their agency as well as incorporate physicians of interests such as breast surgeons, radiologists and oncologists in their discussion panel on mammograms. This would at least give at first blush the appearance of a more independent panal. Breast associations/foundations might be willing to pay the per diems.

I'm hoping this recent windstorm on mammogram guidelines controversy might allow recognition of some of these finer points, with the goal of real transparency on both governments and panels, and with ALL American women and mens safety in mind.

Tender

The task force has decided that 3% isn't enough lives to justify the "risk" (and by risk, they of course mean cost) of annual screening mammograms. They say that the anecdotal/personal stories are of course compelling, but not enough to impact the public policy.

Frankly, I would have an easier time discussing this if they would just state that clearly (as one task force member did on a radio interview I heard today.) The hiding behind the "risk of radiation" which is ludicrous, and even worse, the "stress of the false positive" is insulting to my intelligence, and quite frankly hurts my feelings. Tell me you are OK with me dying from undetected cancer because it's not cost effective to screen me. Don't tell me you're OK with it to prevent women from stress.

The part that has caused me to have a stomach ache for the last few days is the statement that many women in the 40-49 age group have aggressive cancers that don't respond to treatment. In other words, mammography doesn't save their lives, because while it may identify the cancer, the treatment isn't effective. I heard a task force member say that while yes, the screening mamm did detect the cancer,  "the life years gained are not very large" and therefore, it was once again, a "small benefit."

I am still chilled by the lack of emotion on her face as she made that statement.

You know, if the difference in the numbers was larger (ages 50 - 59 = 1300 mamms to save 1 life; ages 40 -49 = 1900 mamms to save 1 life) I think I would have an easier time understanding it. If the age 40 -49 was 5000 mamms to save 1 life, I really think it would be more palatable somehow. 600 just doesn't seem like that much to me.

Moi, I think Obama needs to take responsibility for and be held accountable for what happens on his watch. This happened on his watch. If he is President and is he has no clue what a task force is up to and the damage they are about to inflcit..he should just quit because he is not doing his job. I am will bet $$ that he was involved in this.... people may love Obama..but the guy is not perfect...he does dumb things and makes mistakes like the rest of the world...people need to realize that and call him on it when it happens. Didn't Obama yell during his campaign that his mother died of cancer and he would take care things?? This week, I am thinking he didn't love his mom very much. Well like people can cause much damage and we shouldn't keep someone in office because they have a nice smile while hurting people.

"The task force doesn't argue that mammograms have saved the lives of many women like Sara Fought. In fact, the task force mentions in its statement that for every 1,000 women in their 40s who receive routine mammograms, two cases of cancer are detected. However, it also notes that 98 women will have "false positives." In other words, the mammogram will pick up something that looks like cancer, but that further testing shows actually is not."

 http://www.cnn.com/2009/HEALTH/11/19/mammogram.guidelines.insurance/index.html

I would think that this finding would lead the panel to propose ramping up the efforts to determine how to rule out 'false positives'.  Talk about throwing out the baby with the bath water. 

Excellent point Pretty In Pink...Mammos are good at finding things...and are still evolving as a screening/diagnostic mechanism...they did throw the baby out with the bath water with the task force announement. And what is scary about it is these are supposed to be smart people that did this....sure does make ya wonder!

I'm glad Ann you posted that link here as well...........you go girl!

Edited to add - the link brought me to a sign-in page so the entire text wasn't visible. Could you copy and paste it here Ann?

Moi...keep in mind I never voted for either Bush, and I didn't vote for BO either because I look at the individual not the party affiliation.  BO is acting like we are attacking him personally, as if he is guilty of something.

What I want to know is why this "Task Force" is also suggesting that prostate exams for men should be stopped also and why they are even around making these "Suggestions" that insurances follow...which will be the US  government if BO and the congress gets what they want with the government mandated health insurance.  I do agree that BO needs to get rid of the task force if he wants to prove that he is more than just hot air.