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Lung Screening Proposal Renews Scrutiny of Preventative Services Task Force

Once fairly obscure, the U.S. Preventive Services Task Force has gotten headlines in recent years by questioning the value of mammograms for women in their 40s and recommending that men not have the prostate-specific antigen (PSA) test unless they have already been diagnosed with prostate cancer.

These decisions drew an uproar from patient advocacy groups and members of Congress, who accuse the task force — an independent board of medical specialists selected by the federal Agency for Healthcare Research and Quality — of trying to take away important cancer-screening tools.

Last month, the task force drew a very different kind of rebuke, and this time, it came from what amounts to a peer group. Medicare directed its own high-level committee to examine the task force’s December 2013 recommendation that many current and former heavy smokers ages 55 to 80 should get high-tech scans annually for lung cancer.

After reviewing the scientific research available to the task force, Medicare’s Evidence Development & Coverage Advisory Committee in effect rejected the recommendation, concluding that such widespread (and potentially costly) screening could lead to more harm than good.

Only one of the Medicare panel’s nine voting members said he was confident that the benefits of these CT scans of the lungs outweighed the risks for the Medicare population. The other eight voted that they had little confidence, giving grades of 1, 2 or 3 on a scale of 1 to 5.

Steven Woolf, a former member of the Preventive Services Task Force and a non-voting participant in Medicare’s review, took his former employer to task at the panel’s April 30 meeting.

“In my day, looking at the evidence that has been presented, this would not have received a B recommendation,” said Woolf, now the director of the Center on Society and Health at Virginia Commonwealth University.

As Woolf sees it, the task force has shifted away from its duty to focus solely on the scientific evidence in weighing the merits of preventive services, largely because of the new clout that the 2010 health care overhaul gave to its recommendations. Under the law, while Medicare isn’t bound by the work of the task force, private insurance plans are required to cover services that get the task force’s top ratings of A or B. Woolf says the task force, stung by the backlash against its mammography and PSA recommendations in 2009 and 2012, respectively, may be tilting toward approving services too readily

“Now that this new law has entered into the picture, I worry that the task force members can’t avoid thinking about economic implications, and the impact that this might have on patients,” Woolf said in an interview.

Michael L. LeFevre, the chairman of the task force, declined to comment on the Medicare panel’s vote. In an interview, he stressed that the mandate for the task force has remained unchanged. Its members deliberate intensely over the available evidence of both benefits and potential harms of a service, he said. While the task force members try to insulate this work from political and financial questions, the landscape in which they work has changed in recent years, he added.

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