USPSTF must operate transparently in review of breast imaging guidelines, radiologists charge

The United States Preventive Services Task Force must operate transparently and consult breast imaging specialists as the group considers modifying its influential screening guidelines, experts charged on Wednesday.

USPSTF just recently began this periodic review, detailing the process it will use to determine new imaging recommendations for the world’s most-diagnosed form of cancer. The volunteer, independent group is accepting feedback through Wednesday, Feb. 17, and the American College of Radiology just weighed in.

ACR believes that with so much at stake, the group must operate openly and take cues from one of the specialties most impacted by its recommendations.

“With millions of lives affected, it is imperative that critical decisions affecting citizens’ access to preventive healthcare services not be made behind closed doors without the benefit and protection of well-established federal agency transparency requirements,” ACR chief executive William Thorwarth Jr. wrote Feb. 10.

Among its asks, the college is urging USPSTF to share details about its methodologies, along with the input received during public comment periods. ACR also wants to hear about how the task force analyzes—and decides to accept or reject—such input.

The USPSTF is not bound by the transparency rules that come with being a formal federal advisory committee. However, the ACR believes that the Affordable Care Act has granted the task force a “prominent role” in dictating both public and private coverage of imaging services. Thorwarth and colleagues urged the group to seek feedback from the field before making changes that could reshape Medicare, Medicaid and commercial radiology reimbursement.  

“Breast imaging experts have a high degree of familiarity with the relevant research and the downstream scientific literature that provides important context and understanding,” he wrote. “Selection of such experts should not be made in a manner that reinforces bias against screening mammography; the deliberative process is enhanced when open discussion and debate are embraced.”

The task force last issued breast cancer screening recommendations in 2016, maintaining its controversial 2009 view that women in their 50s should receive mammograms every two years. A number of healthcare groups, including the ACR, have lobbied against such recommendations, instead advocating for USPSTF’s 2002 guidance to screen every 1-2 years beginning at age 40.

You can read the full comment letter from the American College of Radiology here, and the task force’s Draft Research Plan for Breast Cancer Screening here.