The American Cancer Society on Tuesday called for later and less frequent mammograms. It's the first update to the group's breast cancer screening guidelines in more than a decade.
The ACS says most women should start annual screenings at age 45 instead of 40, a change that moves the group closer to guidelines from an influential advisory task force but also illustrates the lack of uniformity among the medical community.
The cancer group also now advises screening every other year beginning at 55, according to an article published Tuesday in JAMA.
Recommendations suggest women should begin annual screening before the age of 45 if they so choose, and should continue getting mammograms if they remain in good health and have a life expectancy of 10 years or longer.
"The most important message of all is that a mammogram is the most effective thing that a woman can do to reduce her chance of dying from breast cancer," said Dr. Richard Wender, the cancer society's cancer control chief.
"It's not that mammograms are ineffective in younger women," he said, but at age 40, breast cancer is uncommon and false alarms are more likely. The ACS encourages women to consult with their physician about the risks and benefits associated with mammography.
The society's updated guidelines say switching to every other year at age 55 makes sense because tumors in women after menopause tend to grow more slowly. Also, older women's breasts are usually less dense, so cancer is more visible on mammograms, said Dr. Kevin Oeffinger, chairman of the society's breast cancer guideline panel and director of the cancer survivorship center at Memorial Sloan Kettering Cancer Center in New York.
Among those with differing guidelines include the U.S. Preventive Task Force, which since 2009 has recommended women begin routine mammography screening at age 50 once every two years. The UPTF has historically influenced Medicare coverage. In draft recommendations released this year, the group said that mammograms for women in their 40s should be an individual decision based on preferences and health history, and that more research is needed to determine potential benefits or harms for scans on women age 75 and older.
The American Congress of Obstetricians and Gynecologists recommends women begin testing annually at age 40, a view shared by the American College of Radiology and the Society of Breast Imaging.
Such differing views can lead to confusion for primary-care physicians. While consensus finds early detection to be a key factor in increasing the survival rate of breast cancer patients, more frequent mammography screening could produce more false positive diagnoses, leading to increased anxiety for patients.
About 230,000 women in the U.S. are diagnosed each year with breast cancer, which ranks as the second leading cause of cancer mortality among women, with more than 40,000 deaths annually.
“I think that the data is complex and the media has gotten involved presenting opinions, so I think primary-care physicians have a really hard time sorting out the information,” said Dr. Susan Harvey, director of the Breast Imaging Section at Johns Hopkins Medicine. “Most of the time we say 'talk to your doctor', but the poor primary-care physicians are asked to be experts in all aspects of medicine, which is unfair and overwhelming.”
Harvey said imaging professionals at Johns Hopkins engage with primary-care physicians to help provide more clarity as to when to conduct screening. They also help physicians sort through the data.
In an accompanying editorial, Dr. Nancy Keating of Harvard Medical School and Dr. Lydia Pace of Brigham and Women's Hospital, Boston, wrote the new ACS guidelines along with the current USPTF recommendations, which are more consistent regarding delayed screening, but conflict in terms of annual or biennial frequency that will require doctors to weigh the risks and benefits of more frequent screening with patients.
“In communicating with patients, clinicians will have to balance the ACS' recommendation for more frequent screening against the fact that younger women experience a lower absolute benefit from screening mammography,” they wrote.
Most health plans are required to cover screening mammograms free of charge as part of preventive care mandated by the Affordable Care Act, and many insurers cover the screenings starting at age 40.
The Associated Press contributed to this report.
