Could Task Force Cancer Screening Recommendations Be a Little Premature ?

The United States Preventive Services Task Force(USPSTF/the Task Force) is a little known public healthy policy entity rarely heard of outside the health industry. But, it has taken to being perhaps the most influential guideline setter for practitioners and cancer screeners alike. But, what has made the elite group so controversial in the last 3 years are its sweeping cancer screening recommendations that have been rocking the medical practitioner and health consumer world , radically. Where most medical practitioners have observed cancer screening recommendations provided by professional specialty organizations and biomedical institutions such as the American College of Obstetrics and Gynecology(ACOG), the American Medical Association(AMA), National Institutes of Health(NIH), or American Cancer Society(ACS) ; the U.S. Health and Human Services has given the nod to the "task force" to become the premiere authority to set all guidelines for all specialties. Many of the "task force's" recommendations appear to be at odds with traditional practitioners and professional organizations. For example in 2009 they struck down the longstanding ACS(American Cancer Society) guideline for all women at age 40 in getting a baseline mammogram and an annual follow-up .The task force recommended to up the age of baseline to age 50. This confounded a number of medical practitioners who still detect a significant number of suspected and actual cancer lesions in women between the ages of 40 to 50. But, what makes the controversy even greater is that the "task force" has found allies in organizations such as the National Womens Health Network , Our Bodies Ourselves, and Breast Cancer Action which have surprisingly stated that there is no benefit in self-breast exams or annual mammograms , but state the opposite; that they may be of little benefit and could be counter productive? Other studies done in Sweden show that there is a correlation between the extra number of rads(radiologic units) and an increase risk of breast cancer. But, this doesn't make practitioners feel anymore "protected" from missed diagnosis and being open for medical malpractice. To practitioners who have long instructed patients to perform self-breast exam it is not only confusing , but counters cost-productive prevention to recommend phasing out the frequency of self-breast exams. Even though the National Cancer Institute(NCI) is still awaiting putting out its official statement on the guidelines, the World Health Organization(WHO) appears to back the "task force's" recommendations as they stand. There already has been a 6 % decrease, nationally, in mammograms which represent 54,000 American women. Both Mayo Clinic and the ACS recommendations conflict with that of the USPTF. Another watershed recommendation in 2009 by the same "task force" was for Pap smears. The nations foremost professional female health organization's guideline had long been accepted for all women to have a pap smear by age 18 or shortly after their first sexual encounter as a baseline . The USPSTF prefers all women wait until age 21 regardless of when their first sexual encounter was. ACOG had made its recommendations mostly due to the fact the human pappilloma virus(HPV), the virus associated with cervical cancer was spread sexually and pre-cancerous lesions such as sexual warts could be prevented from developing into cancer in younger sexually active women. The new USPSTF guidelines even further stretches the intervals for Pap smears in women between 21 and 30 to be done every-other-year , and to be done only every 5 years for women between ages of 30 and 65.These "task force" made its new recommendations only six years after ACOGs a short amount of time. Now a Third recommendation made by the "task force" makes recommendations on the second leading cause of cancer deaths in males, prostate cancer . The "task force" states that there are little benefits and many bad side effects for early prostate cancer detection and prevention. The "task force" states that side effects such as erectile dysfunction, urinary incontinence, bowel dysfunction, pain and death outweigh the benefits of performing early screening. The "task force's" recommendations appears to be in conflict with the clinical experience of urological practitioners. The new recommendations may have only further confused practitioners , particularly when it comes to the apparently simple and quick test called the PSA(prostate specific antigen). The "task force", stated that the PSA has a high false - positive rate which can lead to unnecessary biopsies and surgeries. The USPSTF recommends reducing annual PSA to every 4 years in men between 50 to 74 years of age. But, there is more concern for cutting down the number of PSA screenings. It appears the number of missing earlier detected lesions may also go up as a result. So, what does this all mean in an election year where healthcare appears to be one of if not the key central issue? It means that the recommendations on guidelines by the USPSTF will greatly effect the demographics of those detected and diagnosed . Perhaps the reduced number of screenings in the short run can reduce healthcare spending .However, it could represent "hiding" or misplacing those with early cancer diagnosis. Worse, if there is a delayed reaction of detecting a large minority of undiagnosed cancers, an even larger than anticipated tsunami of cancer will wash up on the shores of the healthcare system potentially wiping out a significant amount of healthcare dollars. Surely actuarial professionals have utilized the biostatistics of epidemiologists on the rising rates of cancers due to obesity in this country to have anticipated these rising demographics and the economic impact it will have. This only makes healthcare a greater "confluence" issue for the election of 2012. Under the new proposal of the Affordable Care Act 30 million uninsured and those effected by the Dream Act also will add to this growing demographic that will effect healthcare costs. As Americans become more obese, more chronic disease and cancers of prostate, bowel, ovaries, breast, and uterus will increase. The new "task force" recommendations only make diagnostics trickier for clinicians to discover what the actual health status of patients is in shorter intervals of time. If a cancer has time to grow; it may mean by the time is is discovered the stage of it can be very serious and more costly. In July of 2013, the "task force" stated it could reduce lung cancer deaths by 20,000 a year by performing 160,000 cat scans on those with the ailment . The problem is that these scans would have to be done monthly, cat scan are expensive in comparison to regular x-rays and radiate 150 to 1000 times more radiation than a simple x-ray. The National Cancer Institute stated that as of 2007, the 72 million CT scans taken could attribute to 29.000 future cancer cases. Doctors at Georgetown are also questioning the new CT scan policy being recommended. It is understandable that practitioners feel more comfortable with the older guidelines that give them more ammunition not only to diagnose earlier disease stages, but also to protect themselves from liability. Some practitioners may the "task force" guidelines limits their ability to practice their art in a more secure professional arena . Also the utility of practitioners may on the surface appear less valuable than before because other allied healthcare workers can perform screening test for a lot less than a medical doctor as well. There are many issues here, but , perhaps the most crucial that was never looked at by Commission on U.S. Federal Leadership in Health and Medicine, that of creating guidelines for a daily healthy lifestyle based on weight, fitness, metabolism and nutritional needs. The commission preferred to look at assisting policies for managed care and those benefiting from an exorbatant rising rate of health services, drugs, and coverage.