Recommendation on Breast Cancer Screening (continued)

Sheryl Stolberg: Sheryl Stolberg, New York Times. I actually have two questions. First, for Dr. Allan, it's my understanding that typically these recommendations would be published in a medical journal and that the publication was actually scheduled for some time in April and that this announcement was moved up. So, I'd like to know if that was correct.

And then for Secretary Thompson, I'd like to know, do you believe that this settles the matter? Is this the Government's final word on the topic? And, if it is, what are women to make of the previous recommendation by the PDQ committee to the National Cancer Institute?

Dr. Allan: In terms of the typical process, we have a variety of ways of publishing the recommendations from the Task Force. And some of the—there are three products. We have Recommendations and Rationale, which you have in your briefing packet, which is aimed at the clinician. This is our advice to the clinician.

We also will often have what we call a Systematic Evidence Review, which is a very long paper, 50 to 150 pages, which is a very detailed account of all of the studies on how those things were reviewed and the conclusions. That evidence review is sometimes turned into a shorter manuscript. So we basically have the Recommendations and Rationale, and sometimes they are sent with a manuscript to a journal to be published together. Other times, the Recommendations and Rationale will go onto the agency's Web site for immediate access for clinicians.

In this case, we have published the recommendations now. They will be on the Web site. There is a manuscript in process, and it is still being developed.

Ms. Sheryl Stolberg: Was the announcement moved up for any reason?

Dr. Allan: No.

Secretary Thompson: Thank you, Doctor.

Dr. Greenwald: If I understood the last part of your question, you were referring to the PDQ Editorial Report? The PDQ system, that means Physician Data Query, is a comprehensive data system maintained by the NCI.

There's a subgroup of that called an Editorial Board that looks at information about screening and prevention. And they meet five times a year and routinely look at things as they come along.

That group reviews the level of evidence for NCI. They do not make recommendations, so they would not be making recommendations about guidance. They did have a meeting, which was reported, where they were discussing what they saw as level of evidence, so they discussed it. They have not written a report and so we have not received their specific views on the level of evidence.

They have another meeting where they may finish writing the report, or they may feel that, now that the U.S. Preventive Services Task Force has come out with new information, that they should consider that. So it's a group that reviews level of evidence and does not make guidance as does the U.S. Preventive Services Task Force.

Secretary Thompson: And the question to me was basically is this the policy and the Government's recommendation? Yes, it is.

Unidentified Man: Mr. Secretary, I understand that this announcement wasn't moved up, but I'm wondering if you can talk about personally whether you felt the need to come out here today to give an endorsement so to speak because of the studies? Did you feel a certain amount of pressure to clarify the Government's position on this?

Secretary Thompson: I didn't feel any pressure. I just felt it was the right thing to do. I felt, you know, there's conflicting information and this affects the health quality of women and families all over America. And women are confused as to whether or not they should go in and have their mammogram done or not.

And I thought, as Secretary of Health, and somebody that personally has gone through this, that it was the right thing to do. I was not pressured. It was my personal decision to come out here and hold this, and ask these lovely doctors to come over here and explain it so that we could get this information out to the American public so that women will go in and receive their mammograms. And that's the conclusion, the only conclusion, that you can draw from this.

Mr. Bill Small: Bill Small, Windward Radio. It's not an area where I just happen to have a great deal of familiarity, but I wanted to ask a question anyhow. Do you expect this to have any sort of impact on the insurance industry, health insurance industry, and what is or is not covered at what age? Will that have any impact at all, or is that...

Secretary Thompson: That's not our intention to have any impact at all. It should be covered as much as possible, that is my personal opinion. But, this press conference and informational gathering from NCI and from the U.S. Preventive Services Task Force is basically to get the information out there to as many women across America as possible.

There's confusion and there's controversy. And we went back and looked over all the policies and we felt, now that this research has been gathered and the conclusions have been agreed upon, the best thing to do is to have a press conference like this so that you individuals would be able to avail yourself of this information, get it out to the American public, and hopefully encourage women, age 40 and older, to go in and have annually, or once every 2 years, have a mammogram. And they should discuss it with their clinician.

Mr. Peter Mayer: Peter Mayer with CBS News. Asking questions of the researchers, why do you think the incidence rate among black women is twice that of the rate among whites?

Dr. Greenwald: We don't have a full answer. We do know that, as a proportion, there's some difference in the type of cancer. For example, in the white population, about 70 percent of the cancer is called "Estrogen Receptor Positive," that is hormonally driven, and 30 percent is called "ER Negative," which is a tougher one to treat. In the African-American population, 40 percent have estrogen receptor negative, so it's higher.

Now, in terms of mortality, there are major issues of access of quality of care, whether they get, on average, the same quality of treatment. So that certainly could affect mortality.

There is one positive thing that, only in the past couple of years, the mortality in black women has started to decline also.

Unidentified Woman: Can you talk a little bit about false positives? I'm wondering what is being done to limit the possibility of a likelihood of getting these false positives?

Dr. Greenwald: Let me just mention a couple of things about false positives. Number one, there have been some refinements and advances since the time of these clinical trials. And one of the advances is treatments are better. They've improved clearly.

A second advance is the technique of biopsy has improved, where now what's commonly used is called a stereotactic biopsy. It's a way of aiming the biopsy needle and getting it right in the spot you want. That means you can do the biopsy more often right away.

In the past, where the doctor might have said let's wait 3 months or 6 months with a questionable lesion, now they might say, since there's less discomfort, not none, but less discomfort and you can hit the lesion, they would go right to biopsy. So there's less of a period of worry.

The other thing is there's research on new technologies. The NCI is sponsoring a very large trial on 49,000 women, comparing digital mammography to regular mammography. Now, we have to prove this, but the potential benefits of digital mammography are, number one, it's better at discerning lesions when women have breasts that are more dense. So, a problem with say the younger women, 40 to 49, is their breasts tend to be more dense and it's easier to have a false negative or a false positive. So the digital may give us a way of doing better.

It also may avoid the need for a repeat mammogram when it's questionable, because you can go back to the computer and refine what you're looking at.

And the third thing it will do is, since the message, the information can be sent over the telephone lines, the radiologist could get an instant second opinion, even if you're in rural Wisconsin, for example. You could wire into one of the major cities from Milwaukee and get a second opinion and, thus have the best experts looking at the lesions.

Secretary Thompson: One final question.

Unidentified: Mr. Secretary, ...a different topic. Today there was a Government report on the HHS Web site called Nursing Home Compare that showed that hundreds of thousands of violations and health violations in nursing homes were omitted. I'm just wondering, why was that information omitted from the Web site?

Secretary Thompson: Well, a lot of that information is being compiled, and we're upgrading the Web site all the time. And, as you probably know, I announced in November of this past year a new demonstration program with five States across America in nursing homes to improve the quality of nursing care. And that program hopefully is going to be able to go nationally.

This Web site is very new and it's working well, but now we have to get more information on there. We must get more people involved in looking at the data coming in.

We're very appreciative of Congress actually encouraging us to do this job even better. But, you have to realize, you can't go there overnight. And this is in the embryonic stages and we're going to compile all this information and that's the reason for the Web site, so that the consumer, the individual either going to the nursing home himself or herself or a member of their family can look it up at our Web site.

It's a great Web site. It will get much better, and we will do more as far as getting more data in. That's what I've instructed The Centers for Medicare & Medicaid Services (CMS) to do, and that's what Tom Scully's going to accomplish.

Thank you all for coming. I appreciate it very much.

Current as of February 21, 2002

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Internet Citation:
Press Conference Transcript: Task Force Recommendation on Breast Cancer Screening. February 2002. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/3rduspstf/breastcancer/transcripta.htm

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