Our Greatest Wealth Is Health

Andrew Siegel MD   5/13/2023

USPSTF: The United States Preventive Services Task Force

Q: Why is a urologist writing about breast cancer screening?

A: I wrote up a piece on the topic of USPSTF absurdities regarding prostate cancer and testicular cancer screening, expecting to upload it today, but this past week the USPSTF revised — yet again — their recommendations for breast cancer screening, and I just couldn’t resist.  Next week I will upload the USPSTF Prostate and Testes Cancer Screening Recommendation Absurdities entry.

On May 9, 2023, the USPSTF modified their recommendation for breast cancer screening (breast clinical exam and mammography), dialing it back to starting at age 40, instead of their previous recommendation of starting at age 50. 

Historically, in 2002 the USPSTF recommended screening beginning at age 40, but in 2009 they changed their tune, deeming it inadvisable that women in their 40s undergo screening, setting off a blaze of controversy.  It will never be determined how many women suffered with a delayed diagnosis of breast cancer, unnecessary morbidity, and mortality as a result of their ill-advised recommendation in 2009.  Their current recommendation on returning to screening at age 40 is predicated on the significant rise in breast cancer rates in women in their 40s, particularly African American women, and the subtext is that the USPSTF made a grave error that has finally been rectified after 15 years of women receiving unsound medical advice.

The USPSTF recommendations have strongly influenced the practice behavior of primary care physicians. However, their recommendations have never been influential to all physicians and many medical societies have not bought into their folly. As opposed to primary care physicians, obstetrics /gynecology MDs have recommended screening mammography to women aged 40-50 and age 70-89 because of their confidence that screening reduces breast cancer mortality.  The American Cancer Society, The American Congress of Obstetricians and Gynecologists, and the American College of Radiology have recommended annual mammography starting at age 40 years.

Breast cancer screening is imperative because breast cancer is common, representing 12.5% of all new cancer cases worldwide. It is the number one cancer diagnosed in American women, occurring in 1 out of every 8 women. In 2022, there were 288, 000 new cases of invasive breast cancer and 51, 000 new cases of in-situ breast cancer. There are 3.8 million breast cancer survivors in the United States. Clearly, breast cancer screening is vital to detect the disease in its earliest and most treatable stages.

The USPSTF aims to improve the health of the nation, focused on preventive services.  They are a circle of supposed “experts” in preventive and evidence-based medicine who provide guidance and direction concerning screening for diseases.  They wield a great deal of power and influence – particularly concerning the medical practice habits of primary care physicians – and have a profound effect on clinical practice guidelines as well as reimbursement.  Over the last four decades, the USPSTF has made many recommendations, some sound, but some unfounded and flawed, to the absolute detriment of the health of the public. 

The USPSTF currently consists of 16 volunteers who have backgrounds in prevention and evidence-based medicine that include the following disciplines: internal medicine, family medicine, pediatrics, behavioral health, obstetrics/gynecology, and nursing.

The USPSTF uses the following grading system:

Grade A: The service is recommended as there is high certainty that the net benefits (benefits minus risks) are substantial.

Grade B: The service is recommended as there is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.

Grade C: There is moderate certainty that the net benefit is small so the service should be offered or provided selectively to patients based upon professional judgment, patient preferences, and individual circumstances.

Grade D: This service is not recommended and in fact discouraged as there is moderate or high certainty that the service has no net benefit or that the harms outweigh the risks. Grade I: Current evidence is insufficient – lacking, poor quality, or conflicting — to assess the net benefits of the service.

The short version regarding their screening recommendations for women in their 40s:

1996: NO

2002: YES

2009: NO

2023: YES

The following summarizes the USPSTF breast cancer screening recommendations from 1996 to 2023:

2023

2009

2002

1996

Bottom Line: The great irony is that while the intention of the United States Preventive Services Task Force is to improve the health of the nation by setting guidelines regarding screening and detecting cancers early on in their natural course, they have actually functioned to “prevent services,” hindering physicians from performing and ordering necessary and appropriate diagnostic tests and doing a disservice to the collective health of the nation.

Wishing you the best of health,

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community. He is a urologist at New Jersey Urology, one of the largest urology practices in the United States.  He is the co-founder of PelvicRx and Private Gym.  His latest book is Prostate Cancer 20/20: A Practical Guide to Understanding Management Options for Patients and Their Families. 

Video trailer for Prostate Cancer 20/20

Preview of Prostate Cancer 20/20

Andrew Siegel MD Amazon author page

PROSTATE CANCER 20/20 is now available at Audible, iTunes and Amazon as an audiobook read by the author (just over 6 hours). 

Dr. Siegel’s other books:

THE KEGEL FIX: Recharging Female Pelvic, Sexual, and Urinary Health

Video on THE KEGEL FIX

MALE PELVIC FITNESS: Optimizing Sexual and Urinary Health

Tags: Andrew Siegel MD, breast cancer, breast cancer screening recommendations, mammography, United States Preventive Services Task Force, USPSTF

This entry was posted on May 13, 2023 at 6:56 AM and is filed under health and wellness. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.