Archive for September 2012
By: Katherine Donigan
It’s been over forty years since President Nixon signed the National Cancer Act, effectively inaugurating the “war on cancer.” In this time, many advancements have been made to further our understanding about the initiation and progression of many different types of cancers. Significant progress has been made in the treatment of specific types of cancer (particularly childhood leukemias), however cancer remains a leading cause of death worldwide (i). Our increased knowledge about the progression of cancer from primary tumor formation to advanced metastatic disease has underscored the importance of early detection through preventive screening. Preventive screening aims to identify tumors at early stages before they have the opportunity to invade surrounding tissues and form satellite tumors (metasteses) throughout the body. Catching cancer in these early stages is crucial, as the majority of cancer-related deaths are attributed to metastatic disease. Therefore, it seemed logical that more screening would result in fewer deaths from cancer.
In 1984, the U.S. Preventive Services Task Force (USPSTF) was established by Congress to objectively evaluate existing scientific data regarding the effectiveness of preventive screening tests, medications and/or counseling (ii). The USPSTF is comprised of primary care providers with expertise in evidence-based medicine and preventive care. Recommendations provided by the USPSTF have mainly been used by physicians when determining whether to order preventive screening tests or medications. Insurance companies have been increasingly looking to the USPSTF recommendations to inform coverage decisions. Medical societies also utilize task force findings to generate clinical guidelines for their members. The USPSTF recommendations are therefore extremely far-reaching, as they inform both doctors who order tests/medications and insurers who pay for them.
The recently enacted Affordable Care Act (ACA) includes a preventive care provision, seeking to “help make prevention affordable and accessible by requiring health plans to cover recommended preventive services without charging a deductible, copayment or co-insurance” (iii). The ACA defines “preventive care” with a specific list that includes services such as immunizations and screening for certain types of cancer. The ACA requires these services to be covered at specified intervals and age thresholds based upon USPSTF recommendations (iv).
However, when these recommendations conflict with those supported by various medical societies, what metric should be used to define what is covered and what isn’t? Read the rest of this entry »