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Radiologists: Get Mammograms Early, Often

2 Groups Call for Annual Breast Cancer Screening at Age 40 for Average-Risk Women

By Daniel J. DeNoon
WebMD Health News

Reviewed By Louise Chang, MD

Jan. 6, 2010 -- Blasting new breast cancer screening advice from a Health and Human Services Department panel, radiologists say women need annual mammograms starting no later than age 40.

Recent guidelines from the U.S. Preventive Services Task Force (USPSTF) -- an outside group of experts that makes health recommendations based on the best available evidence -- call for women to start every-other-year screening at age 50 unless they are more comfortable with starting earlier.

That change from annual screening beginning at age 40 is "ill advised and dangerous," say the American College of Radiology and the Society of Breast Imaging.

Claiming that the new guidelines will cause "countless unnecessary breast cancer deaths each year," the groups call for a return to annual screening at age 40 for average-risk women, and annual screening starting at age 30 (or even as early as age 25) for higher-risk women.

The USPSTF calculates that the greatest benefit of breast cancer screening is for women ages 60 to 69. Evidence on women 75 years or older does not exist. For younger women, the USPSTF calculates that to extend the life of a just one woman, 1,904 women ages 40 to 49 and 1,339 women ages 50 to 59 must be screened.

That's where the debate begins. A woman's risk of breast cancer starts rising sharply at age 40. The USPSTF calculates that breast cancer risk gets large enough by age 50 to justify the "potential harms" of screening. These harms include anxiety over false-positive results and painful, unnecessary biopsies. The radiology groups say the risk at age 40 already justifies any such harm -- and that catching cancer at an earlier stage prevents the harm of more difficult late-stage treatment.

Because women have been taught for years that breast cancer is most curable and most easily treated when caught early, the USPSTF guidelines were met with a public uproar. Health and Human Services Secretary Kathleen Sebelius soon told women under 50 that the suggested guidelines would not become federal health policy.

Now radiologists have officially joined the uproar. Memorial Sloan-Kettering radiologist Carol H. Lee, MD, chairwoman of the American College of Radiology Breast Imaging Commission, condemned the USPSTF recommendations as "unfounded."

"The USPSTF recommendations are a step backward and represent a significant harm to women's health," Lee says in a news release. "At least 40 percent of the patient years of life saved by mammographic screening are of women ages 40 to 49."

Lee and colleagues put forth the radiologists' own guidelines in a strongly worded article in the January issue of the Journal of the American College of Radiology. Those recommendations include:

  • Regular annual screening beginning at age 40 for women at average risk of breast cancer.
  • Regular annual screening beginning at age 30, but not before age 25, for women with increased risk of breast cancer due to BRCA1 or BRCA2 gene mutations, a mother or sister with premenopausal breast cancer, or both a maternal and paternal relative with premenopausal breast cancer.
  • Regular annual screening should continue for all women with a life expectancy of less than five to seven years, based on age or health conditions.

While the USPSTF has already softened the wording of its original guidelines, the panel continues to recommend mammograms every other year.

As for women under age 50, the USPSTF now suggests that the decision to start breast cancer screening "should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms."

SOURCES: News releases, American College of Radiology.

Lee, C.H. Journal of the American College of Radiology, vol 7: pp 18-27.

U.S. Preventive Services Task Force: "Screening for Breast Cancer," updated December 2009.

WebMD Health News: "New Mammogram Screening Guidelines FAQ."

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