June 25, 2012 (Chicago, Illinois) — The House of Delegates of the American Medical Association (AMA) voted here at the AMA 2012 Annual Meeting to support insurance coverage for screening mammography. The AMA further stated its belief that beginning at age 40 years, all women should be eligible for screening mammography.
This differs from the recommendations of the United States Preventive Services Task Force (USPSTF), which concluded that routine screening should begin at age 50 years and continue biennially until age 74 years. The USPSTF recommendations were updated in 2009 and differ from the recommendations of several other guideline-making groups.
The House also voted to adopt the AMA’s Council on Science and Public Health’s report entitled “Screening Mammography.” The report highlights current screening mammography guidelines, explores the established benefits and harms of mammography, and reviews the process by which the USPSTF developed its updated recommendations on screening mammography.
The report includes a comprehensive literature review of papers published between 2000 and 2012 with the terms “screening mammography,” “mammography and USPSTF,” and “mammography and 40.”
Screening Mammography Reduces Mortality
The AMA Council on Science and Public Health concluded that “screening mammography reduces mortality from breast cancer, including in women younger than age 50.”
The report includes a description of the harms associated with mammography that underlie the differences between the mammography screening recommendations. These harms include false-positive and false-negative results as well as overdiagnosis.
The science and technology reference committee heard a great deal of testimony on the resolution and report. Many delegates were supportive of the resolution as written, and many others suggested that the report be referred back to the council and rewritten to include emerging data on digital mammography. Testimony noted that although digital mammography is more common now, all of the recommendations are based on film-screening data.
Bill Bowmon, MD, from the North Carolina delegation, for example, stated that, “There is recent and emerging evidence that has not been considered or cited in this paper.” Marcel Salive, MD, from the US Preventive Health Services in Rockville, Maryland, disagreed, however, saying, “We can’t prejudge what’s going to come out next year. Nobody knows.”
Many delegates were worried that the lack of consensus would confuse patients. Scott Karlan, MD, alternate delegate from California, acknowledged the lack of consensus, but argued for the report, stating, “This report is an attempt to bring clarity about the fact that there is a lack of data.”
Len Lichtenfeld, MD, a delegate representing medical oncology agreed, adding: “The reality is that there are very competent experts who come down on both sides of this issue…. What we have is what we have.”
The testimony then turned back to the specific resolution. Dennis Gralinsky, MD, from the American College of Radiation Oncology, was uncomfortable with the way the resolution discussed the risks associated with mammography. “I, especially, have some patients where…the fears of things…are a problem.” Steven Chen, MD, from the American Society of Breast Surgeons, felt that the resolution also did not optimally discuss the benefits of mammography, “There is a lack of information on the benefits of reducing morbidity…. These are definite benefits that are not considered.”
The approved resolution supports the efforts of organizations to educate physicians and the public about the value of screening mammography, as well as its limitations. It encourages physicians to have regular, thoughtful, and deliberate discussions with individual patients about each patient’s unique risk/benefit situation. The risk/benefit balance may change annually as a patient’s family history becomes updated with information about hereditary cancer.
American Medical Association (AMA) 2012 Annual Meeting. Presented June 21, 2012.
— Laura C. Pullen, PhD0