Who Needs a Mammogram?
Many of our patients have had questions about the change in recommendations recently released by the U.S. Preventative Service Task Force (USPSTF) regarding mammograms for women in their 40’s. In 2002, the USPSTF recommended screening every 1 to 2 years for women aged 40-74. They now recommend against routine screening for women in their 40’s though they acknowledged the decision of when to start should be based on the individual patient’s characteristics, including the patient’s values about specific benefits and risks. They continue to recommend biennial screening from age 50-74. They also recommended against teaching breast self exam (BSE).
The USPSTF recommendations were based on recent studies published November 17, 2009 in the Annals of Internal Medicine. These showed that both women in their 40’s and women in their 50’s have an equal decreased risk of dying from breast cancer if they get routine screening mammograms. However, women in their 40’s may have denser breasts and so are more likely to require additional imaging studies and perhaps breast biopsies to rule out breast cancer. This could result in harm from radiation exposure, false-positive and false-negative results, overdiagnosis, pain during procedures, and anxiety. The USPSTF decided that for women in their 40’s the risk of harm was greater than for women above 50 but the likelihood of benefit was less since only about half as many women in their 40’s actually have breast cancer identified on routine screening.
The American College of Obstetricians and Gynecologists (ACOG) has also reviewed recent data on risks and benefits of mammograms. At the present time, they recommend:
• Screening mammography every 1-2 years for women aged 40-49 years
• Screening mammography every year for women age 50 or older
• BSE; BSE has the potential to detect palpable breast cancer and can be recommended.
The American Cancer Society (ACS) also continues to recommend routine screening for women 40 and above. The Department of Health and Human Services (HHS) is not changing their current funding guidelines for women 40 and above.
Your doctors here at WPMG support ACOG guidelines until there is compelling evidence to the contrary. We will also individualize recommendations for high risk women.
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