Eight months ago, a federal advisory panel triggered an uproar by saying most women needed fewer mammograms and should begin them at a later age. Today, the confusion over those guidelines has intensified as physicians and lawmakers demand they be withdrawn.
The recommendations suggested women without risk factors for breast cancer could wait until 50 to start annual screening. Within a day of their release, Health and Human Services Secretary Kathleen Sebelius issued a statement saying the guidelines didn't represent government policy, and advised women to "do what you've always done."
But the guidelines from the U.S. Preventive Services Task Force, a panel of outside experts chosen by HHS, are still on an official government website run by Health and Human Services although they have been modified to say women between 40 and 49 who want a mammogram should get one if their doctor recommends it.
Still, the furor over the guidelines will not go away.
Sen. David Vitter (R-La.) wrote to Sebelius in May saying passage of the Patient Protection and Affordable Care Act in December required that the government withdraw the guidelines.
Vitter said the bill, passed by a bipartisan vote, called on HHS to remove the recommendations from its website and "cease all promotion of the November 2009 recommendations related to breast cancer screening and mammography."
In his letter, he wrote: "The fact that these recommendations are still being presented to the general public as 'current' is only serving to further confuse women on this critical issue. The recommendations were ill-conceived from the start. . . . They represent a step backward in our fight against a horrible disease."
Vitter spokesman Joel DiGrado said they haven't received a reply from Sebelius. "The senator's office has not heard anything back from HHS. This is not all that untypical for an agency. Their responses to formal letters can take quite some time."
Newsday made several attempts to get HHS to address the status of the guidelines - whether the agency still endorses them now that they've been edited, or whether they will be withdrawn, as some lawmakers are seeking. The agency did not provide answers and no one from HHS would address whether scrapping the guidelines is seriously under discussion.
Dr. Christine Hodyl, director of breast surgery at South Nassau Communities Hospital in Oceanside, said she never took the guidelines seriously - they're unrealistic for Long Island. "This week alone," she said recently, "I operated on two women. One was 37 and the other was 41. Here on Long Island, the breast cancer rate is so high I tell women to get their baseline [first mammogram] at 35 to 40. If these [two] women had waited until 50, the cancer would have metastasized."
Another critic, Dr. Brian O'Hea, director of the Carol M. Baldwin Breast Care Center at Stony Brook University Medical Center, said he never stopped recommending routine screening at age 40. "We're still in line with the American Cancer Society and have not changed a bit," O'Hea said.
None of the task force members were experts in breast cancer or mammography.
Health care insurers, such as Empire BlueCross Blue-Shield and Vytra, say they are sticking with the cancer society's recommendations.