Task force: Mammograms an option at 40, do more good at 50

January 11, 2016 byLauran Neergaard
Task force: Mammograms an option at 40, do more good at 50
In this May 6, 2010 file photo, a radiologist uses a magnifying glass to check mammograms for breast cancer in Los Angeles. Mammograms do the most good later in life, a government task force said Monday in recommending that women get one every other year starting at age 50, and that 40-somethings make their own choice after weighing the pros and cons. (AP Photo/Damian Dovarganes, File)

Mammograms do the most good later in life, a government task force declared Monday in recommending that women get one every other year starting at age 50. It said 40-somethings should make their own choice after weighing the pros and cons.

When to start routine and how frequently to get them has long been controversial. The latest guidelines from the U.S. Preventive Services Task Force stick with its advice that should one every two years between ages 50 and 74. But they also make clear that it's an option for younger women even though they're less likely to benefit.

Some health groups urge mammograms every year starting at 40—although last year the American Cancer Society upped its starting age to 45.

There is some common ground emerging, that mammography advice shouldn't always be one-size-fits all. "Age 50 isn't magic," said task force past chairman Dr. Michael LeFevre of the University of Missouri.

Here are some things to know about mammograms.

___

WHAT THE TASK FORCE SAYS

Women in their 60s are the most likely to avoid dying from thanks to mammograms, but there's clearly enough benefit for the average woman to start at 50, the task force found.

The advisory group wants younger women to understand the trade-offs before deciding: Among every 1,000 women screened, one additional death could be prevented by starting mammograms at 40 instead of 50. But there would be 576 more false alarms and 58 additional unneeded biopsies. Also, two extra women would be overdiagnosed, treated for cancer that never would have become life-threatening.

Monday's update, published in Annals of Internal Medicine, is largely a rewording of guidelines originally issued in 2009 and reconsidered in draft form last spring. This time, the task force stresses that "we think the science supports a range of options" for 40-somethings, LeFevre said.

___

DIFFERING GUIDELINES

Mammograms aren't perfect, and different health organizations weigh the trade-offs differently. So do women and their physicians.

The American Cancer Society says to begin annual mammograms at 45 but switch to every other year at 55. After menopause, tumors tend to grow more slowly and women's breast tissue becomes less dense and easier for mammograms to penetrate, says chief medical officer Dr. Otis Brawley. Between ages 40 and 44, when breast cancer is especially uncommon, the society also says women should make their own choice.

"We're moving away from paternalistic medicine where we doctor organizations used to tell women, 'You must do this,'" Brawley said. "We're saying, 'This woman is at higher risk, therefore maybe she should get screened at 40. This woman is at lower risk, maybe she can wait a little later.'"

The American College of Obstetricians and Gynecologists stands by annual mammograms starting at 40, while urging patient education and shared decision-making.

___

THINGS TO CONSIDER

More than 200,000 women are diagnosed with breast cancer each year, and about 40,000 die from it. It is most frequently diagnosed among women ages 55 to 64, and the median age of death from breast cancer is 68.

Women with a mother, sister or daughter with breast cancer have a higher risk than the average 40-year-old. Other factors can play a role, too, including genetics, breast density and menstrual and pregnancy history.

___

PERSONALIZED SCREENING

Dueling guidelines mean "some people get so confused they don't get screened at all. Some are too anxious or afraid not to do more, and it may not be better for them," said breast cancer specialist Dr. Laura Esserman of the University of California, San Francisco. "Maybe we should be screening in a new way."

Esserman leads the first-of-its-kind WISDOM study that soon will begin enrolling 100,000 women to test whether tailoring screening to someone's individual risk is better than age-based mammograms. Women given annual mammograms starting at 40 will be compared with others assigned more or less frequent screenings, starting at different ages, based on in-depth risk assessments.

___

INSURANCE COVERAGE

Insurance usually pays for mammograms. Because of concern about how the task force recommendations might be implemented, Congress recently extended for two years legislation preserving access to routine mammograms without copays starting at age 40.

___

WHEN TO STOP

The task force says more research is needed to know whether to continue mammograms at 75 and beyond. The cancer society says to keep screening as long as women are in good health and have a life expectancy of at least 10 years.

___

WHAT'S NEXT

The said more research is needed to tell if newer 3-D mammograms should be used for routine screening and if women with dense breasts benefit from extra testing, such as with ultrasounds or MRIs.

The cancer society's Brawley said the mammogram age argument has distracted from a bigger urgency: "We ought to say this more: We need a better screening test for ."

___

Online:

Task Force: www.screeningforbreastcancer.org

WISDOM study: www.wisdomstudy.org

Explore further: Task force: Mammograms in 40s a choice, but don't skip at 50

Related Stories

Task force: Mammograms in 40s a choice, but don't skip at 50

April 20, 2015
A government task force says women should get a mammogram every two years starting at age 50—but starting in their 40s should be a personal choice.

What do the new breast cancer screening guidelines recommend about when to start yearly mammograms?

November 2, 2015
In October, the American Cancer Society (ACS) updated its guidelines for when women at average risk should be screened for breast cancer. These new recommendations are less straightforward than past versions, resulting in ...

False-positive mammograms may indicate increased risk of breast cancer later

December 2, 2015
Main Finding(s): Women with a history of a false-positive mammogram result may be at increased risk of developing breast cancer for up to 10 years after the false-positive result.

Doctors, women should spend more time discussing mammograms

August 9, 2011
Due to changing guidelines concerning when and how often they should first be screened for breast cancer with mammograms, many women are confused. The American Cancer Society recommends women 40 years and older get a mammogram ...

Doctor group seeks to clear confusion in cancer screening

May 18, 2015
Mammograms at 40 or 50? Every year or every other year? What's the best colon check?

What age should women start mammograms? The two sides of the screening debate

November 1, 2013
Mammography works: It can detect cancer. On that point, at least, most experts agree.

Recommended for you

Drug suppresses spread of breast cancer caused by stem-like cells

December 12, 2017
Rare stem-like tumor cells play a critical role in the spread of breast cancer, but a vulnerability in the pathway that powers them offers a strategy to target these cells using existing drugs before metastatic disease occurs, ...

MRI scans predict patients' ability to fight the spread of cancer

December 12, 2017
A simple, non-invasive procedure that can indicate how long patients with cancer that has spread to the brain might survive and whether they are likely to respond to immunotherapy has been developed by researchers in Liverpool.

Insights on how SHARPIN promotes cancer progression

December 11, 2017
Researchers at Sanford Burnham Prebys Medical Discovery (SBP) and the Technion in Israel have found a new role for the SHARPIN protein. In addition to being one of three proteins in the linear ubiquitin chain assembly complex ...

Glioblastoma survival mechanism reveals new therapeutic target

December 11, 2017
A Northwestern Medicine study, published in the journal Cancer Cell, has provided new insights into a mechanism of tumor survival in glioblastoma and demonstrated that inhibiting the process could enhance the effects of radiation ...

A new weapon against bone metastasis? Team develops antibody to fight cancer

December 11, 2017
In the ongoing battle between cancer and modern medicine, some therapeutic agents, while effective, can bring undesirable or even dangerous side effects. "Chemo saves lives and improves survival, but it could work much better ...

Liver cancer: Lipid synthesis promotes tumor formation

December 11, 2017
Lipids comprise an optimal energy source and an important cell component. Researchers from the Biozentrum of the University of Basel and from the University of Geneva have now discovered that the protein mTOR stimulates the ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.