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March 8, 2016

A Public Health Framework for Screening Mammography: Evidence-Based vs Politically Mandated Care

Author Affiliations
  • 1Department of Family Medicine, Georgetown University Medical Center, Washington, DC
  • 2O’Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, DC
JAMA. 2016;315(10):977-978. doi:10.1001/jama.2016.0322

In November 2009, in the midst of acrimonious congressional debates over the Affordable Care Act (ACA), the US Preventive Services Task Force (USPSTF) updated its breast cancer screening guidelines. The Task Force recommended biennial mammography screening for women of average risk aged 50 to 74 years, sparking a torrent of criticism. Although the ACA mandated insurance coverage for USPSTF-recommended preventive services, it went further for mammography screening. Instead of relying on the most recent USPSTF guidelines, Congress amended the ACA to require the Department of Health and Human Services (DHHS) to use its 2002 guidelines, which recommended screening every 1 to 2 years starting at age 40 years.