Monday, February 8, 2010

More on USPSTF and Breast Cancer

The controversy over the USPSTF Government Review Panel on Breast Cancer still rages amongst Radiologists. In a recent article in Journal of Diagnostic Medical Sonography and as written up in Aunt Minnie, the Radiologists web site they state:

Guidelines for mammography screening published by the U.S. Preventive Services Task Force (USPSTF) in November not only are based on flawed methodology, they also fail to address current breast imaging practice and data, making them obsolete, according to a critique published in this month's Journal of Diagnostic Medical Sonography.

The article continues:

Author Kevin Evans, Ph.D., evaluated the USPSTF's report methodology and found that it did not meet established standards for systematic reviews (JDMS, January/February 2010, Vol. 26:1, pp. 19-23). Evans is chair of the radiologic sciences division in the School of Allied Medical Professions at Ohio State University in Columbus.

Evans used two resources to evaluate the USPSTF's report: the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), a 27-point checklist, and the Assessment of Multiple Systematic Reviews (AMSTAR), an 11-point checklist.

The task force's report scored 7 out of 27 on the PRISMA checklist and 1 out of 11 on the AMSTAR list. These low methodological scores put in question the rigor used in developing the report, limiting it to a review of literature instead of a formal systematic review and reducing its overall scientific impact to a much lower level in the hierarchy of evidence, according to Evans.

"I picked two of the most well-known methods to evaluate systematic reviews and applied them to the report," he told "It's possible that USPSTF met these standards but failed to provide their methodology in the report. This becomes problematic in reading their guidelines."

Needless to say the critical review calls into serious question the whole issue of Comparative Clinical Review by a Centralized Government Panel. As we have argued for well over a year, the CCE or CCR proposal are one of the weakest elements of the current Administration's Plans but on the other hand they go to the heart of their belief that a centralized Governmental solution is the only solution.