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

Abstract

This Viewpoint highlights the societal risks of politically motivated mandates relating to public health guidelines. Although the Affordable Care Act mandated insurance coverage for U.S. Preventive Services Task Force (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 1-2 years starting at age 40. The FY 2016 Consolidated Appropriations Act instructs DHHS to interpret any reference to “current” USPSTF breast cancer screening recommendations to mean those issued “before 2009” — in other words, its 2002 recommendations. Essentially, Congress is requiring health insurers to ignore modern scientific assessments, and instead use 14-year-old guidance. The ACA improved the public’s health by guaranteeing that insurers provide uniform, cost-free access to preventive services based on modern evidence of effectiveness. The public’s health is best served when women’s personal decisions about screening are informed by evidence rather than political considerations. The Congress’s paternalistic response to USPSTF mammography-screening recommendations vividly illuminate the social costs of politically mandated care. Rather than benefiting women, political interference with science can discourage shared decision-making, increase harms from screening, and sow public doubt about the value and integrity of science.