When a government advisory panel put out new recommendations last week that said women under age 50 need not be screened for breast cancer, the calls began flowing to Sen. Barbara A. Mikulski's office. Within days, the Maryland senator had responded with an amendment to the Senate's pending health care reform bill that would guarantee access to mammograms at age 40 through public insurance exchanges.
With the health legislation as the backdrop, politicians in Maryland and across the country have reacted swiftly to the breast cancer lobby - a group that has made early screening a mantra and pink ribbons a powerful symbol in fighting the most commonly diagnosed cancer in women. They have also heard from doctors' groups and those who claim that the recommendations from the U.S. Preventive Services Task Force signal rationing of health care under reform.
Rebecca McCoy, grants and education program manager for the Maryland branch of the Susan G. Komen for the Cure foundation, said the group's national leadership has set up a petition that could be used to rally support on Capitol Hill.
"Mammography isn't perfect, and we know that," McCoy said. "But we've heard from a lot of supporters. It's an emotional issue. It's personal. We've heard from supporters who were diagnosed in their 40s or they know someone who has been diagnosed."
McCoy said the Komen group, like most others, agreed with the task force that mammography finds false results and can cause anxiety for women in their 40s. Younger women tend to have more dense breast tissue, which make the X-rays less accurate in finding tumors. But, she said, the test is useful in finding cancer and shouldn't be abandoned before better technology is developed. The group is supporting Mikulski's amendment.
McCoy and others fear insurers will stop paying for routine screening for women older than 40, which is now offered by private insurers in most every state and by the federal government through Medicaid and Medicare. Health and Human Services Secretary Kathleen Sebelius said that was unlikely to happen, and some major insurers have told the news media they do not intend to change their polices.
The breast cancer lobby isn't the only force on the issue, said Lisa Dubay, an associate professor of health policy at Johns Hopkins Bloomberg School of Public Health.
There also are health care reform foes who are using the new recommendations in an attempt to derail legislation. The political posturing has upped the ante in an already emotional discussion, she said.
"That discussion is still important and would still occur, but because we are talking about health care reform, the reaction has been off the charts," said Dubay, adding advocates have very real concerns.
"What people worry about is the one case where you wouldn't catch a cancer, and that results in someone's loss of life - and that's real," she said. "I don't think that's an unwarranted fear."
The debate over the new guidelines reflects a confounding issue in medicine as the nation struggles to rein in health care costs, she said.
On one hand is the push to use science-driven evidence to determine effective treatment. And on the other are patient advocates and some doctors with personal anecdotes of how the tests saves lives. Their wrenching tales run counter to the data, and to them, the notion that looking for cancer early can cause more harm than good seems counterintuitive.
"I think this sort of foreshadows how difficult it will be to have these discussions in our country," she said. "It think it gets very politicized and is a very difficult conversation to have. But they are conversations that we have to have and most other industrial countries have. We need a mechanism for controlling costs and for providing evidence-based high-quality medicine. But getting there is going to be very hard."
Mikulski said in an e-mail Friday that she proposed the mammogram amendment because she feared the task force's recommendations could roll back progress in fighting breast cancer.
"We've fought to make sure women have access to early detection and screening for breast cancer to help save lives while we are working on a cure," she wrote. "I believe that where data is conflicting, it is better to be safe than sorry."
Officials at the American Cancer Society Cancer Action Network say they support evidence-based methods for making recommendations about preventive services, though the group has rejected the latest mammography guidelines.
Those recommendations were made out of the "public eye and with little or no input from the broader patient or scientific community," said John R. Seffrin, the group's chief executive officer, in a statement. Lawmakers, he said, should now make changes to bolster public confidence in the task force.
For now, the current policy of screening women in their 40s should continue, said Dr. Reuben Mezrich, chair of the diagnostic radiology and nuclear medicine department at the University of Maryland Medical Center.
He agreed with the task force's conclusion that mammography isn't perfect, but he said it is the best life-saving method widely available now to find breast cancer and should continue to be deployed. Technology is advancing, Mezrich said. There's now digital mammography. MRIs are even better, but too expensive. Eventually, there may be a blood test, but that's far off, he said.
Mezrich praised the breast cancer, or "pink," lobby for helping more women gain access to mammography.
"It's a good thing there is a pink lobby," he said. "Mammograms are one of the few screening studies covered by insurance, and that shows the effectiveness of the lobby. They should lobby for more."