White House backs off cancer test guidelines

By Rob Stein and Dan Eggen
Washington Post Staff Writer
Thursday, November 19, 2009; A01

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."

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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