New advice: Skip mammograms in 40s

November 17, 2009 6:38:15 AM PST
A government health task force is offering new recommendations when it comes to mammograms for breast cancer screening. The results offer a major reversal that challenges the American Cancer Society's advice and is sure to cause confusion for women and their doctors.

Current guidelines say women should start getting mammograms annually at age 40. The new recommendations say most women should wait until age 50, and even the ACS is reconsidering its stance as women in their forties have fewer cancers than older women.

Annual screening with mammograms can reduce deaths from breast cancer in woman 50 and older. But for women in their 40s, there's controversy. Is once every two years okay?

To resolve confusion, the task force made a dramatic departure from standard advice. They advise no mammograms for 40-somethings and, beginning at age 50, a mammogram every two years would be enough to catch the majority of cancers.

The report compared several large studies, acknowledging that mammograms miss some cancers and mislabel normal lumps. It's a thoughtful look at women in their 40s, says Dr. Freya Schnabel.

"What are the the disadvantages of screening younger women?" she asked. "How many of them will have to undergo repeated examinations and biopsies?"

But a bi-annual screening in 50 year olds may allow small cancers to grow larger, meaning the need for extensive chemotherapy and radiation.

These new recommendations apply to women at normal risk for breast cancer. They don't apply to women at high risk, those with a family history of breast cancer, with breast cancer genes or other high-risk factors.

The guidelines should be followed carefully, based on present screening, the cornerstone of which is multiple large studies done all over the world for the past 50 years. Dr. Schnabel says the new recommendations will help average risk-women who are willing to take a bit more risk.

"This gives them some opportunity to have some real evidence behind that strategy, to employ it and to be screened every other year," she said.

The present lumpectomy is based on early detection of small cancers and couldn't be done without screening to catch small tumors, which pretty much depends on yearly mammograms. But the ideal would be to learn which cancers are aggressive and which are slow-growing, so treatment can be individualized to each woman.

The answer to the obvious question is presently unknown. Will insurance companies use these guidelines to limit the number of mammograms covered under insurance plans? Only time will tell.