Despite new recommendations, women in 40s continue to get routine mammograms at same rate

Women in their 40s continue to undergo routine breast cancer screenings despite national guidelines recommending otherwise, according to new Johns Hopkins research.

In 2009, the U.S. Preventive Services Task Force (USPSTF) sifted through the evidence and recommended that while women ages 50-74 should continue to undergo mammograms every two years, those between the ages of 40 and 49 without a family history of breast cancer should discuss the risks and benefits of mammography with their physicians to make individual decisions.

As a result of the altered recommendations, Lauren D. Block, M.D., M.P.H., a clinical fellow in the Division of General Internal Medicine at the Johns Hopkins University School of Medicine, and her colleagues expected to find fewer women in their 40s getting routine mammograms. Instead, they found no impact on mammography rates among younger women.

"Patients—and likely their providers—appear hesitant to change their behavior, even in light of evidence that routine screening in younger women carries substantial risk of false positives and unnecessary further imaging and biopsies," says Block, leader of a study published online in the Journal of General Internal Medicine. "Women have been bombarded with the message 'mammograms save lives,' so they want them no matter what."

That research has shown that mammography's impact on younger women is mixed at best: routine screening increases rates of detecting cancer in young women, but reduces by a very small percentage. It is more likely, studies show, to result in over-diagnosis, and unnecessary treatment, including biopsies, lumpectomies and mastectomies, and weeks of radiation and potentially . False positives result in avoidable procedures and . Many of the cancers detected will probably never be dangerous, but are aggressively treated.

Among older women, are recommended because breast cancer, like most cancer, is a disease of aging, and a woman's risk of breast cancer increases as she grows older.

The original USPSTF guideline change recommended more forcefully against routine screening for women in their 40s, but a political and advocacy group backlash resulted in compromise language that counseled individual decision-making by patients and physicians. The American Cancer Society continues to recommend yearly mammography for women starting at age 40.

Moreover, Block says, insurance companies continue to pay for routine mammograms for women in their 40s—a likely reason for the persistently high rate of screening.

Block and her colleagues analyzed mammogram use data from Behavioral Risk Factor Surveillance System surveys administered in 2006, 2008 and 2010 by state health departments nationwide. Data from 484,296 women ages 40 to 74 were collected. Among women in their 40s, 53 percent reported having a mammogram in the past year in 2006 and 2008, compared with 65 percent of women ages 50 to 74. In 2010, after the new recommendations had been in effect, 52 percent of younger women and 62 percent of older women reported having a mammogram.

The USPSTF recommendations also say there is no benefit to screening women at normal risk of breast cancer over the age of 75.

Block says she sees the same reluctance among her 40-something patients to change course on mammography when she has the conversations about the pros and cons. Some of her patients are relieved that they can postpone mammography until age 50. Many more, however, want to continue being screened.

"Breast cancer gets so much attention in the media and in society in general, despite cardiovascular disease being by far the number one killer in women. Everyone wants to feel as though they are preventing ," Block says. "You hear one anecdotal story about someone in their 40s who found cancer during a mammogram and did really well with treatment and that's enough to fly in the face of any other facts that are out there. want the test."

add to favorites email to friend print save as pdf

Related Stories

New studies show effects of mammography guideline changes

Nov 27, 2012

Researchers assessing the impact of revised guidelines for screening mammography issued by the U.S. Preventive Services Task Force (USPSTF) found evidence that the new recommendations may lead to missed cancers and a decline ...

Recommended for you

Pepper and halt: Spicy chemical may inhibit gut tumors

5 hours ago

Researchers at the University of California, San Diego School of Medicine report that dietary capsaicin – the active ingredient in chili peppers – produces chronic activation of a receptor on cells lining ...

Expressive writing may help breast cancer survivors

7 hours ago

Writing down fears, emotions and the benefits of a cancer diagnosis may improve health outcomes for Asian-American breast cancer survivors, according to a study conducted by a researcher at the University of Houston (UH).

Taking the guesswork out of cancer therapy

12 hours ago

Researchers and doctors at the Institute of Bioengineering and Nanotechnology (IBN), Singapore General Hospital (SGH) and National Cancer Centre Singapore (NCCS) have co-developed the first molecular test ...

Brain tumour cells found circulating in blood

13 hours ago

(Medical Xpress)—German scientists have discovered rogue brain tumour cells in patient blood samples, challenging the idea that this type of cancer doesn't generally spread beyond the brain.

International charge on new radiation treatment for cancer

14 hours ago

(Medical Xpress)—Imagine a targeted radiation therapy for cancer that could pinpoint and blast away tumors more effectively than traditional methods, with fewer side effects and less damage to surrounding tissues and organs.

User comments