There are a few things you should know about Janice Davis. She's been married for 25 years, she's a mother, grandmother, dog lover, and a breast cancer survivor.
"I had no family history," Davis says. "I didn't expect that to happen."
But the unexpected became a reality for Davis 16 years ago when she was 49 years old. For almost a decade she had been following her doctor's advice and getting annual mammogram screenings. But that last time was different.
"I kept putting it off and putting it off, and you know, you get busy and think well, I need to do that, I need to do that, but I didn't do it for a whole year," Davis says.
Many medical professionals recommend that women begin annual mammogram screenings when they turn 40. One in every six women diagnosed with breast cancer is in their 40s.
USPSTF releases recommendations on screening mammograms
"I would have never found it doing a self-exam because it was back further toward my chest wall."
"What the 'C' grade says is we want women to make their own choice," says Dr. Kirsten Bibbins-Domingo, the immediate past chair of USPSTF. "We want them to use the science to make a decision about when to screen after talking with their doctor."
During a Skype interview, Bibbins-Domingo said the 'C' grade means women in their 40s don't benefit from annual screenings as much as older women. That's why screening regularly for women between the ages of 50 and 74 was given a 'B' grade. Bibbins-Domingto says women in their 40s are more likely to receive false positive results.
But some healthcare professionals, including Northwest Radiology breast imaging specialist Dr. Parin Bhayani, are concerned about the task force's recommendations.
Bhayani says the purpose of screening mammograms is to pick up cancer well before a woman can feel it, and more importantly, before it can spread.
"So if you extend the screening recommendations to every other year or two years, well that certainly gives the cancer a much larger chance to grow in those two years and spread, which is not what we want," Bhayani says.
The task force recommendations are meant for a broad audience, including physicians and patients, but health insurance companies also use the recommendations to determine how to set policies.
For example, the Affordable Care Act covers preventative services with at least an 'A' or 'B' grade. So, if a service gets a 'C' grade, there is a chance insurance providers would stop covering it. It's unclear if that would actually happen with mammogram screenings.
Protecting Access To Lifesaving Screenings Act
Republican Congresswoman Susan Brooks, who represents Indiana's 5th district, doesn't want to chance it. Along with Florida Rep. Debbie Wasserman Schultz, Brooks co-authored the Protecting Access to Lifesaving Screenings Act as an effort to postpone any actions based on the task force's recommendations until 2020.
"If these task force recommendations go into place...fewer physicians will recommend their patients get mammograms."
"We know that young women of all ages and even men on occasion get breast cancer, but we know that screenings are important and if these task force recommendations go into place, fewer physicians will recommend their patients get mammograms," Brooks says.
The bill has to make it through the U.S. Congress first, and it's unclear if it will move forward as a stand-alone bill or as part of another piece of legislation.
Brooks says she doesn't care how it moves forward. But she says there should be a consensus on the guidelines, and those guidelines should be made in the spirit of doing what is in the best interest of women. This also comes at a time when the future of healthcare is uncertain. Brooks voted in favor of the House version of the Republicans' efforts to repeal and replace the ACA. She hasn't yet spoken publicly about the Senate version.
Bibbins-Domingo says USPSTF doesn't determine insurance coverage policies. Its role is to look at the science.
"I can't use the science to manipulate the grade we give a particular recommendation," Bibbins-Domingo says. "Our job is to report on what the science is telling us."
She also points out that although there are differences, the USPSTF recommendations and the American Cancer Society's guidelines, for example, embody similar key principles.
"That is that mammography is an important tool to help women reduce their chance of dying of breast cancer, [and] the value of mammography increases with age, such that women in their 50s and 60s are most likely to benefit from mammography screenings," Bibbins-Domingo says. "There is benefit to screening in the 40s, and the decision to screen in the 40s should really be an individual choice that reflects the woman's preferences, family history."
This week, the American College of Obstetricians and Gynecologists released guidelines similar to USPSTF's recommendations. The group previously recommended beginning annual mammogram screenings at age 40. Now, it says the screenings should be offered at age 40, but that women should talk with their doctors first to make the best decision.
Davis says without the mammogram screening in her 40s that revealed cancer, the outcome for her could have been much different.
"The lump that I had, I would have never found it doing a self-exam because it was back further toward my chest wall," Davis says. "If I would have waited much longer, it probably would have been very much advanced, maybe I wouldn't have lived through it, I don't know."
Davis tells friends and family to have screenings done every year, so if the unexpected does happen, it is more likely to be treatable.
