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White House backs off cancer test guidelines

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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Under health-care reform legislation pending in Congress, the task force's recommendations would be used to help determine the basic coverage that insurance companies would need to offer for preventive services. But task force officials said that played no role in the panel's decision and costs were never considered. In fact, the task force decided to review the mammography guidelines and completed the bulk of its work years before the presidential election and the reform push, Ned Calonge, the panel's chairman, said in an interview.

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.

Sebelius's statement was welcomed by proponents of routine mammography.

"Hopefully this will help reduce some of the confusion and anxiety that this has created," said Daniel B. Kopans, a professor of radiology at Harvard Medical School. "There needed to be someone with a voice who would be heard who would say that this was just one committee's opinion."

But supporters of the new guidelines said they were deeply disappointed by the move, especially coming from an administration that has said its decisions would be driven by science and not politics.

"This should not be an issue of political pressure or public pressure," said Fran Visco, president of the National Breast Cancer Coalition, which supports the task force's findings. "It should be an issue of what the science says and what's best for women. We're not rationing care; we're doing what's best for the health of women."

Some speculated that the administration fears that opponents of health-care reform will use the issue to undermine support for an overhaul, in the same way that critics charged over the summer that reform would lead to "death panels" to decide whether lifesaving care would be given.

"They obviously don't want a return of the death panels at this stage," said Howard Brody, a professor of medical humanities at the University of Texas at Galveston.

'How rationing begins'

A group of female GOP lawmakers attacked the task force's recommendations during a news conference Wednesday, arguing that the guidelines would deprive patients of needed care and that they provide a glimpse of the dangers of an increased government role in health care.

"This is how rationing begins. This is the little toe in the edge of the water," said Rep. Marsha Blackburn (R-Tenn.). "This is when you start getting a bureaucrat between you and your physician. This is what we have warned about."

Congressional Democrats said privately that they will distance themselves from the guidelines -- which they think could become a political problem -- while attacking Republicans as seeking to politicize the issue.

Some Democrats attempted to respond to the GOP allegations, arguing that the recommendations are reasonable and accusing Republicans of cynical politics.

"If we can cut through the Republicans' political gamesmanship on this issue, the new breast cancer recommendations, as always, were an attempt to put the best possible evidence in the hands of women and their doctors, so they can assess their own risk and benefit," Rep. Rosa DeLauro (Conn.) said in a statement.

Staff reporters Michael D. Shear and Perry Bacon Jr. contributed to this report.

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