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Feeling farther from the finish

By Dana Milbank
Tuesday, November 24, 2009

Nancy Brinker, the breast cancer activist who painted the world pink, was feeling blue.

She spent three decades keeping women abreast of the need for cancer detection with her pink ribbons and her Race for the Cure, and the percentage of U.S. women receiving mammograms nearly doubled, to two-thirds. But then last week, in one cruel and clumsy blow, a federal task force wiped out much of the progress. No more routine mammograms for those under age 50, the panel recommended, less-frequent mammograms for those 50 and over, and no more teaching women to examine their own breasts.

The recommendations "have taken a tremendous toll, and I believe they set us back," Brinker told reporters at the National Press Club on Monday afternoon. "The women I have heard from, thousands and thousands and thousands, are justifiably outraged and worried and angry."

The work was undone by the U.S. Preventive Services Task Force, a group of 16 academics and medical experts under the chairmanship of Ned Calonge, a Colorado public health official. Before it attacked mammography, this same panel called for less screening for prostate, colon and skin cancers (it did, however, recommend aspirin to fight heart attacks and strokes).

The problem is less the science behind the recommendations than the cloddish way the panel has rolled them out (the latest one coming in the middle of a charged health-care debate in Congress). With a drumbeat of recommendations raising doubts about various cancer screenings, the public could easily get the mistaken impression that all cancer screening is a waste of time and money. "After all we've done to urge people to get screened, now they hear maybe they shouldn't bother. That's dangerous," Brinker said. "We spent a long time acculturating people to be curious and active participants in their care."

The task force's message also contradicts that of President Obama, who frequently touts the value of mammograms in his health-care speeches. A "step that we can all agree on is to invest more in preventive care," he has said. "It means going in for that mammogram or colon cancer screening."

And yet Obama can't fire the members of the task force: They're independent and unaccountable.

Many oncologists, no doubt, would like to send Calonge and his colleagues off to Gitmo, where they could live out their years happily denying one another cancer screenings. Luckily, Congress has a simpler solution at hand: It can abolish the task force and turn it into a group that is more accountable to the public. Under the House version of health-care legislation, the task force, whose members need not subject themselves or their opinions to public comment or public hearings, would be reorganized as a federal advisory committee subject to oversight. Their scientific judgments would stay independent, but the group would no longer be able to go rogue with surprise recommendations.

"The behavioral piece wasn't focused on as much as it should have been," Brinker said, lamenting that the task force would discourage the poor and others whose "ability to show up to take a mammogram or a screening or be involved in health care is fragile."

Brinker, who started Susan G. Komen for the Cure after her sister died of breast cancer, is a formidable figure. Tall and striking, with heavily styled hair and heavy lip gloss, she stood behind the lectern with hands clasped behind her back. On her lapel was the ubiquitous pink ribbon, a symbol of the enormous success of her organization, which earned her an ambassadorial appointment from President George W. Bush, a Presidential Medal of Freedom from Obama, and a stint as a goodwill ambassador with the World Health Organization.

Her answers were so clipped that the moderator quickly ran out of questions and called a premature end to the session. But that didn't matter: It took only a couple of minutes for Brinker to deliver her scolding of the federal task force. "What works is what we know: early detection, awareness, research and treatment, and, yes, screening, mammography and self-awareness," she said. "Let me say it as clearly as I can, as a breast cancer survivor whose breast cancer was found with a mammogram at the age of 37. . . . Mammography saves lives." Her deceased sister, she added, learned of her cancer "without the benefit of the mammogram."

And Calonge's task force? "It was a total surprise about the way it was announced," Brinker said, and "a little clumsy." But after the furious reaction of the last week, generated in no small part by Brinker herself, she was left feeling more pity than anger for the task force. "I'm glad I'm not a member of the panel, to tell you the truth," she confided.

It must be awful. All the more reason for Congress to take pity on the panelists and send the task force to the Death Panel for a humane end.

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