Doctors Group Faults Guidelines for Mammograms & Prostate Cancer Test
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CHICAGO — Recent recommendations on breast cancer and prostate cancer screening made by a government-appointed panel did not include enough input from experts in treating these cancers, doctors said here today (June 19).

The American Medical Association voted today to officially express concern over the U.S. Preventive Services Task Force recommendations on mammography and prostate specific antigen (PSA) testing.

"We have concerns that adequate input from specialists in these areas is not given or enlisted," when the task force makes its recommendations, said Dr. Robert Hughes, president of the Medical Society of the State of New York.

In 2009, the task force recommended women receive regular mammograms starting at age 50, going against the common practice of screening women beginning at age 40. And recently, the task force recommended against PSA testing for men altogether.

Hughes said that doctors' reactions to these recommendations have been "outrage, disappointment, frustration [and] sadness."

"They put undo emphasis on possible risks, without adequately emphasizing the obvious benefits of early screening," which include early diagnosis and treatment of cancer, Hughes said.

The task force has said the risks of screening, which include unnecessary tests and anxiety caused by false-positive results, do not outweigh their benefits. In addition, the task force said evidence shows men who receive prostate cancer screening do not live longer than men who don't receive screening.

The task force is made up primarily of experts in evidence-based medicine, preventive care and primary care.

Doctors here said the task force does not have enough input from specialists when making its recommendations.

The new AMA policy says the organizations should encourage task force "to implement procedures that allow for meaningful input on recommendation development from specialists and stakeholders in the topic area under study."

The task force does hold a comment period for their recommendations, but some doctors feel these periods are not enough, and do not adequately engage medical specialists societies, Hughes said.

In response to the resolution, Dr. Michael LeFevre, vice co-chair of the U.S. Preventive Services Task Force, said that the task force has always involved specialists in the process of making their recommendations. For instance, the task force reaches out to experts within a given field to review a draft of the recommendations.

The only steps specialists are not involved in is the final evaluation and vote on the recommendations, LeFevre said.

The task force also has a rigorous conflict of interest policy, LeFevre said. Financial and intellectual conflicts (such as having conducted a research study on the topic in the past) are must be declared, and may exclude people from participating in the final vote. Most often, those who are excluded from voting are those with financial conflicts (such as stock in a company that would benefit from a given screening test), LeFevre said.

Editor's note: This article was updated on June 20 to include comments from the U.S. Preventive Services Task Force.

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