April 24, 2015 / 5:50 PM / 4 years ago

U.S. data show that mammograms still often begin at 40

(Reuters Health) - Despite 2009 recommendations to stop giving women under 50 screening mammograms, the rate of first mammograms occurring at age 40 is on the increase, according to a new study.

In 2009, the U.S. Preventive Services Task Force (USPSTF) updated its screening guidelines to recommend mammograms every two years for women 50 to 74 years old who were not at heightened risk for breast cancer.

In an update this week, the panel noted that women, especially those at high risk for breast cancer, should consult with their doctor at around age 40 about the right time to start screening (see Reuters story of April 20, 2015, here: reut.rs/1OHrVLF).

“There has been continuous debate surrounding the 2009 USPSTF recommendations and benefits and harms of mammography in women ages 40 to 50 years in medical literature,” said lead author of the current study, Dr. Soudabeh Fazeli Dehkordy of the University of Michigan Health System in Ann Arbor.

“Several prominent professional and advocacy organizations continue to recommend screening for younger women,” which may have limited wider adoption of the 2009 recommendations, Dehkordy told Reuters Health.

The USPSTF is an independent, volunteer panel of national experts in evidence-based medicine that reports to Congress each year.

The American Cancer Society, a nonprofit corporation, disagreed with the 2009 guideline, and continues to recommend that yearly mammograms begin at age 40.

Dehkordy’s team used data from surveys in the years before and after the USPSTF recommendation – 2007, 2008, 2010 and 2012 - to look at patterns in women’s use of mammograms by age.

Screening rates were lower overall in 2010 and 2012 than in previous years, the authors report in the American Journal of Preventive Medicine, but the proportion of women who began getting screened at age 40 increased, and was highest after the USPSTF recommendations were issued in 2009.

“The data in our study demonstrated a decrease in mammography screening rates at age 35 to 36 years and an increase at age 40 years between 2007 and 2012, which may reflect the 1992 recommendation of the American Cancer Society to initiate mammograms at age 40 years rather than age 35 years,” Dehkordy told Reuters Health by email.

There may be a similar delay for uptake of the 2009 USPSTF recommendations, she said.

“Our goal with this recommendation is to communicate what the science tells us about the age and intervals at which screening mammography provides the best balance of benefits and harms,” USPSTF vice chair Dr. Kirsten Bibbins-Domingo told Reuters Health in a statement.

The most common harm of mammography screening is false positive results, when a test result seems to indicate cancer is present, but it is not, which causes anxiety for the patient, she said.

The most serious harm is overtreatment of a cancer that would not become a threat during the woman’s lifetime, she said.

“Varying recommendations from medical organizations may contribute to women and their doctors following differing recommendations,” Bibbins-Domingo said. “However, we all want better screening, better treatments, and better ways to prevent breast cancer.”

“Although there is general agreement between various guidelines on benefits of routine screening mammography, for some patients, mammography screening can lead to unnecessary, invasive diagnostic procedures such as breast biopsy and treatment for tumors that may not have become clinically significant,” Dehkordy said. “The ratio of these possible harms to benefits is greater in women younger than age 50.”

But some younger women may be willing to accept the possible harms of mammography and request one from their doctor, she said. Public and private insurance continues to cover annual mammograms for women age 40 to 50, strengthened by an Affordable Care Act requirement.

“If the new recommendations are proven to be successful, specific implementation barriers should be identified and addressed to improve new guidelines implementation,” Dehkordy said.

SOURCE: bit.ly/1IiXh9x American Journal of Preventive Medicine, online April 2, 2015.

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