Physicians “Strongly Urge” Govt To Reconsider

Some half a dozen local Obstetricians and Gynecologists have written a letter saying they “support annual mammography screening beginning at age 40″ and “strongly urge the government to reconsider prematurely passing their proposed legislation especially given that this legislation is based on draft recommendations that have not even been adopted and are not supported by ACOG, ACS nor ACR.”

The letter, which was sent to the Minister and obtained by the media, said they write as the collective voice of the majority of the local Obstetricians/Gynecologists to present their professional comments on the proposed legislation that affects breast cancer screening.

The letter follows below:

We write as the collective voice of the majority of the local Obstetricians/Gynecologists [women's health care specialists] to present our professional position, comments and opinions in respect of the Government of Bermuda’s proposed legislation re breast cancer screening.

Firstly, it would seem imprudent to propose and subsequently pass legislation that is based on draft recommendations from the USPSTF before final recommendations are released or even adopted.

We all trained in and/or are board-certified or board-eligible under the U.S. system.

The American Congress of Obstetricians and Gynecologists [ACOG], which represents 90% of U.S. board-certified Ob/Gyns, has reaffirmed its position in response to the USPSTF draft recommendations. In its Practice Advisory on breast cancer screening published April 20, 2015 ACOG continues to recommend that screening mammography be offered to women age 40 years and older. As members of ACOG we support this position. [The ACOG Practice Bulletin on Breast Cancer Screening published in 2011 and reaffirmed in 2014 can be provided upon request.]

Other U.S. medical organizations that also currently recommend annual screening beginning at age 40 include the American Cancer Society [ACS], the American College of Radiology [[ACR] and the Society for Breast Imaging [SBI].

We wish to point out that in its draft recommendations the USPSTF states “the decision to start screening mammography in women prior to age 50 years should be an individual one. Women who place a higher value on the potential benefit than the potential harms may choose to begin biennial screening between the ages of 40 and 49 years.”

In contrast, under the Bermuda government’s proposed legislation only “women with a family history or other risk factors will still be covered for testing with a physician referral at any age.”

We should emphasize that 75% of breast cancers occur in women without a family history or other risk factors.

Whilst we are not validating or endorsing this, we also draw attention to a press/news release from the American College of Radiology [ACR] dated April 20, 2015. In the press release the ACR states “Adoption of draft USPSTF breast cancer screening recommendations would result in thousands of additional and unnecessary breast cancer deaths each year.”

The release goes on to state “The USPSTF does not comply with the Institute of Medicine [IOM] recommendations for guideline development – widely regarded as the medical standard. The methods used by USPSTF do not meet the IOM thresholds to be considered ‘trustworthy guidelines’. No breast cancer experts sit on the task force that created these recommendations. The USPSTF did not allow participation of breast cancer or breast screening experts at meetings where evidence was reviewed.”

To reiterate our position we, the majority of the local Ob/Gyns, support annual mammography screening beginning at age 40. We also strongly urge the government to reconsider prematurely passing their proposed legislation especially given that this legislation is based on draft recommendations that have not even been adopted and are not supported by ACOG, ACS nor ACR.

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