Health minister Jeanne Atherden has responded to allegations by Kim Wilson that changes in mammograms services could cause “death by delay”.

In the statement, Ms Atherden said the suggestion by the shadow minister was “misleading”, and that the Bermuda Government is not introducing legislation telling women they can have a mammogram only once every two years.

“The said amendment in the Health Insurance (Miscellaneous) Amendment Act 2015 seeks to ensure the coverage for Bermuda’s minimum health insurance package — the Standard Hospital Benefit (SHB) is grounded on evidence-based medicine, and in line with international best practice, with respect to screening mammography,” she said. “Women with a family history or other risk factors will still be covered for testing with a physician referral at any age.

“This amendment seeks to assure that women obtain physician input in the decision to use this technology in young ages where the science indicates that the benefits do not outweigh the risks.”

She said the health system right now informally follows the American College of Radiology guidelines for mammography, which recommends annual screenings for women aged 40 and over.

“A clinical review of various international guidelines from several countries has proposed changing the Bermuda standard to follow the United States Preventive Services Task Force (USPSTF) guidelines which recommend that healthy, asymptomatic women aged 50 to 74 years be screened every two years,” she continued.

“The USPSTF guidelines are recommendations which review, analyse, interpret and then report the evidence from a multitude of studies conducted by international subject experts.

“The recommendations are agreed upon using a robust methodology by a panel of esteemed physicians and researchers representing a variety of fields. The task group has a rigorous screening process to assure the members have no substantial conflicts of interest which would bias their opinions. Although the members represent multiple disciplines, all scientific fields cannot be represented on the task force for practical purposes.

“The Task Force is comprised of scientists and medical experts on prevention. The decisions are made purely on scientific analysis of the harms of over-diagnosis and the benefits of early detection. As in all aspects of science, there is never perfect consensus on any topic among even the experts; likewise there is variation in the opinions around screening mammography

“Locally, physician leaders from the Bermuda Medical Doctors Association, the Bermuda Medical Council, and the Bermuda Hospitals Board, support the recommendation in addition to the Bermuda Health Council. The USPSTF was identified as a reasonable set of guidelines for our health system as they are moderate in nature, falling somewhere between the recommendations of individual speciality groups in the USA (such as American College of Radiology) and the UK’s National Institute for Heath and Care Excellence guidelines.

“It is important to note again that unanimous agreement on a standard is not a realistic expectation, but the standard of evidence provided by international studies has produced international consensus on the benefits of starting screening at age 50.

“Any woman with an immediate family member with the disease, dense breasts or who have used hormones after menopause for five years, plus other risk factors known to the patient and her physician, will have full access to all mammography coverage necessary, as they do now.

“The decision of when to screen or not with mammography should be made by a woman and her physician, after consultation together. Starting screening mammography at 50 is recommended by international leading agencies and experts.

“Bermuda considered clinical guidelines from the US, the UK and Canada which ranged from annually from age 40 to every three years from age 50. The decision to use the USPSTF guidelines was based on the fact that international studies have found that annual screening for women with no symptoms and no risk factors leads to over-diagnosis, which results in repeated exposure to low levels of radiation and unnecessary treatment. The guidelines are highly credible and based on extensive meta-analyses of international studies.

“There is no local study to support the notion that Bermudians of African descent might benefit from earlier detection, and neither of our guest prevention experts (Dr Welch or Dr LeFevre), nor the physician representatives collaborating in support of adherence to USPSTF Guidelines, are aware of any study data that support improved outcome and less harm from “over-diagnosis” in such a subpopulation who are systematically screened earlier.

“It’s imperative to remember that these are screening procedures for women with no symptoms, no family history and no risk factors. Black women in Bermuda who do have a family history or specific risk factors will be referred for mammography by their physician and it will be covered under the standard health benefit.

“The legislative change clearly states that it is covered outside the guideline if there is a physician referral. Any insured woman at any age with a family history or other risk factors known to the patient and her physician will have full access to all mammography coverage necessary, as they do now.”