Task force: Mammograms an option at 40, do more good at 50

Women who were not known to be at increased risk of breast cancer should start biennial mammography screening at age 50 and continue through age 74, according to a final recommendation issued by an influential USA panel Tuesday. As for women with higher than average risk, including those who have a family history of breast cancer, the new guidelines do not apply for them whatsoever.

“If followed, new U.S. Preventive Services Task Force breast cancer screening recommendations will result in thousands of unnecessary deaths each year and thousands more women enduring extensive and expensive treatment than if their cancer had been found early by an annual mammogram”, the American College of Radiology and the Society of Breast Imaging, said in a joint statement released Monday.

New Guidelines for the recommended age to get a breast cancer mammogram were released by the U.S Preventive service today.

The Task Force is continuing to recommend mammograms every year for women ages 50 to 74.

After years of fervent activism, public health messaging and medical practice, the mammogram has become an annual ritual for many women over 40 in the United States. “The USPSTF underestimates the undeniable life-saving benefits of screening mammography and overestimates the potential risks”, he said. Specifically, a family history of breast cancer, high breast density, and previous benign breast biopsy result were statistically significant risk factors for false positive results across age groups.

One in eight women are or will be diagnosed with breast cancer in the US, but doctors have been divided on the appropriate age to start screening for the deadly disease.

The mammography guidelines have been issued along with four editorials and seven supporting articles on Monday in the Annals of Internal Medicine.

For the task force guidelines, research was led by the Cancer Intervention and Surveillance Modeling Network (CISNET), and funded by the National Cancer Institute.

Is there a concern that these guidelines may add to the confusion that already exists regarding the optimal frequency of breast cancer screening?

Dr Esserman is leading a study that will soon enroll 100,000 women to test whether tailoring screening to someone’s individual risk is better than age-based mammograms.

Its recommendations are basically the same as in 2009, when the panel of experts ignited a firestorm of controversy by saying that the evidence does not support routine mammograms for women between the ages of 40 to 49 who are at average risk of breast cancer.

Further research may prove 3-D mammography effective in certain women where older technologies fall short.

The task force also couldn’t say, based on the evidence available, whether additional screening tools like ultrasound or MRI could help women with dense breasts screen for cancer.

Dr. Laura Peterson with Kapi’olani Medical Center for Women & Children says, “until all the society’s agree, it’s an individual decision”.

Following the American Cancer Society’s new recommendation.

When do women get the most benefit from mammograms to find breast cancer?

For those who don’t fit into that category, she said, “my best advice is determine individualized risk and what a woman is comfortable with, recognizing there are going to be false positives and the risks of harm”.

Some women, regardless of age, are hesitant to go in for the test. “Our 2009 recommendation has been incorrectly interpreted as a recommendation against screening for women in their 40s”. “…The potential benefits of preventing breast cancer deaths are real, but the likelihood of those benefits is small and no definitive evidence shows that screening reduces total mortality”.

The Task Force does not make recommendations for or against insurance coverage and its final recommendations do not impact insurance coverage for breast cancer screening. For example, under the Affordable Care Act, insurance companies are only required to cover screening tests for which the task force assigns a grade of A or B. Later this month, the USPSTF, ACS and other organizations will convene for the first-ever Breast Cancer Screening Consensus Conference, organized by the ACOG, which they hope will be a forum to discuss streamlining recommendations.