U.S. physicians move to more flexible mammogram schedule

NEW YORK (Reuters Health) - Women at average risk for breast cancer should be offered screening mammograms every year or two starting at age 40 and they should start regular screening no later than age 50, an influential U.S. group of obstetricians and gynecologists said on Thursday.

Amid divided expert opinions on whether more screenings are beneficial, the American College of Obstetricians and Gynecologists (ACOG), which previously recommended yearly screenings starting at age 40, wants to stress shared decision-making between women and their doctors based on their personal preferences in the new, more flexible schedule.

The updated recommendation is more in line with other prominent organizations, including the American Cancer Society and the U.S. Preventive Services Task Force.

“We want women to feel empowered that they are participants in this process and that their values and preferences are an important part of the decision-making process,” said Dr. Christopher Zahn, who is ACOG’S vice president of practice.

The updated recommendations pose yet another change in the already complex landscape of guidelines suggesting when women of average risk should begin breast cancer screening.

The 2016 guidelines from the U.S. Preventive Services Task Force recommends screening mammograms every other year starting at age 50, but offers women the option to begin screening at age 40. The American Cancer Society recommends screening should be offered starting at age 40, but it recommends annual screening beginning at age 45, then tapering off to screening every other year starting at age 55.

Dr. Otis Brawley, chief medical officer for the American Cancer Society, said the recommendations of the various groups may be confusing but they are more evidence-based than decades ago.

“Medicine is getting much more interested in what the evidence actually shows,” he said.

Brawley said there is likely a group of women in their 40s who will benefit from mammography screenings, but there is also a group that will likely be inconvenienced and possibly harmed during follow-up testing.

“One needs to weigh the benefits and harms and make a decision you feel comfortable with,” Brawley said.

For example, one woman may feel the possible harms of excessive worry or overtreatment are outweighed by a lower risk of death from breast cancer, while a younger woman may say the slightly decreased risk of death is not worth the trouble.

“What we’re saying is that the patient really needs to be involved in that decision,” Zahn said.

SOURCE: Obstetrics and Gynecology, online June 22, 2017.

Reporting by Andrew Seaman in New York; Editing by Marguerita Choy