Breast-cancer flap gets political

WASHINGTON — The Obama administration distanced itself Wednesday from new standards on breast-cancer screening that were recommended this week by a federally appointed task force, saying government insurance programs would continue to cover routine mammograms for women starting at age 40.

As the task-force recommendations stirred concern among women and came under fire from lawmakers of both parties, Obama administration officials emphasized that they were not binding on either physicians or insurers. Administration officials also fired back against Republicans who argued that the recommendations illustrated the dangers of an expanded government role in medical decision making.

Democrats on Capitol Hill acknowledged that the recommendations, amid negotiations over a health-care overhaul, had handed Republicans a vivid new way to raise the specter of rationing.

The issue illustrated the political sensitivity of restructuring the health-care system, and trying to reduce costs, by using science-based protocols to minimize unnecessary procedures and tests. Even as the White House tried to reassure women that the recommendations would have no immediate force, a group of doctors that analyzes new research for the National Cancer Institute said it would include the guidelines in the information for doctors and the public.

Kathleen Sebelius, secretary of health and human services, acknowledged that the recommendations, by the U.S. Preventive Services Task Force, had "caused a great deal of confusion and worry." Sebelius then stressed that the task force "is an outside independent panel of doctors and scientists who make recommendations" and who neither "set federal policy" nor "determine what services are covered by the federal government."

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

On the White House blog, Dan Pfeiffer, the deputy communications director, wrote that "women who are currently getting mammograms under Medicare will continue to be able to get them."

"There are no plans to change that," Pfeiffer said.

The Medicare program, which primarily covers those 65 or older but also insures younger people with disabilities, pays for annual mammograms starting at 40. Coverage policies for Medicaid, the shared state and federal health insurance program for low-income people, are set by the states.

Neither Sebelius nor Pfeiffer explained why the government would not embrace the recommendations from the task force, which is appointed by Sebelius' department.

James Thrall of the American College of Radiology, which condemned the guidelines, praised Sebelius' statement but called on the secretary to order the task force to rescind its recommendations "in order to avoid confusion as health-care reform moves forward."

The task force advised Monday that most women should not start routine screening until they are 50, as opposed to the current standard of 40. The reason, according to the task force, is that studies show that "the additional benefit gained by starting screening at age 40 years rather than at age 50 years is small, and that moderate harms from screening remain at any age."

While the downsides of mammography have not received much attention, cancer researchers say they are real and include excess biopsies, unnecessary anxiety and the discovery and treatment of tumors that would not cause problems if left alone.

The task force encouraged younger women with known risk factors for breast cancer, such as a genetic mutation, to make individual decisions with their physicians about mammography. It also recommended that women 50 to 74 be screened every two years rather than annually. It also discouraged doctors from teaching breast self-examination.

Several Republican women in the House, including Rep. Cathy McMorris Rodgers of Washington, used the new guidelines to highlight what they said were the dangers of increasing the government's role in health care under the Democratic legislation.

"This is the little toe in the edge of the water," said Rep. Marsha Blackburn of Tennessee. "This is where you start getting a bureaucrat between you and your physician."

Under legislation in the House and the Senate, the federal government would devise a package of essential benefits that insurers would be required to offer in standard policies sold through a new government marketplace, or exchange. A new government insurance plan that would be created under the House bill would have to offer the same minimum benefits.

It was not just Republicans who expressed dismay. Rep. Debbie Wasserman Schultz, D-Fla., who voted for the health-overhaul bill in the House, said she was "very concerned" that the recommendations conflict with those of other authorities, such as the American Cancer Society.

Meanwhile, the physician group that evaluates new research on cancer screening for the National Cancer Institute determined that the task-force evidence was important enough to be added to the information it gives to doctors and the public.

The group, Physician Data Query, does not make recommendations for the National Cancer Institute, but the institute said Monday that it would review the new guidelines and issue a statement.

Gardiner Harris contributed reporting. Material from The Washington Post is included in this report.