White House backs off cancer test guidelines

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Secretary of Health and Human Services Kathleen Sebelius addresses the controversy surrounding a government panel's decision to advocate mammograms starting at 50, not 40. Sebelius does not refute the decision but tells women to "do what you've always done."

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By Rob Stein and Dan Eggen
Washington Post Staff Writer
Thursday, November 19, 2009

A top federal health official said Wednesday that the controversial new guidelines for breast cancer screening do not represent government policy, as the Obama administration sought to keep the debate over mammograms from undermining the prospects for health-care reform.

Health and Human Services Secretary Kathleen Sebelius, in a written statement, said the new guidelines had "caused a great deal of confusion and worry among women and their families across this country," and she stressed that they were issued by "an outside independent panel of doctors and scientists who . . . do not set federal policy and . . . don't determine what services are covered by the federal government."

Sebelius's statement challenged the recommendations of that influential panel, the U.S. Preventive Services Task Force, made up of independent experts assembled by her department to address one of the most explosive issues in women's health.

The task force on Monday recommended that women in their 40s not undergo routine mammograms and instead individually discuss with their doctors whether to have the exams. The panel also said that women in their 50s should have routine mammograms every two years, instead of annually. The panel argued that the benefits of more frequent routine exams were outweighed by the harm caused by false positives, which can lead to anxiety, unnecessary biopsies and unneeded treatment.

While hailed by many patient advocates and breast cancer experts, the new guidelines have been harshly criticized by the American Cancer Society, the American College of Radiology and others, including some members of Congress. Some have questioned whether the guidelines are related to the health-care reform debate and efforts to save money by rationing care -- allegations the panel strongly denied.

"The task force has presented some new evidence for consideration but our policies remain unchanged," Sebelius said in the statement. "Indeed, I would be very surprised if any private insurance company changed its mammography coverage decisions as a result of this action."

She added: "My message to women is simple. Mammograms have always been an important life-saving tool in the fight against breast cancer and they still are today. Keep doing what you have been doing for years -- talk to your doctor about your individual history, ask questions, and make the decision that is right for you."

Worried that the guidelines might complicate the health-care debate, the White House has swiftly reacted to the panel's decision. By Tuesday night, the rationing argument had made it to Fox News, prompting a quick response on an administration blog.

And as some Republicans were raising the specter of rationing Wednesday morning, White House officials were distancing the administration from the panel's recommendations. On Wednesday afternoon, Sebelius expressed that view forcefully, though officials said her statements were more a disagreement with the science than part of the political pushback.

In an interview, White House spokesman Dan Pfeiffer said that "this would be a provably false and entirely disingenuous attack, but that hasn't stopped the opponents of health reform to date."

In an e-mail Wednesday night, an administration official said that Sebelius "issued the statement because we are concerned in all the back and forth that women don't know the facts and have been led to believe that they are losing coverage for mammograms."

In an interview Wednesday on CNN, Sebelius said that the task force members "do not make policy decisions. They don't make coverage decisions. And that's really the critical piece."


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