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Experts question new mammogram guidelines

October 20, 2015 | Patricia Harriman
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Not everyone agrees with the American Cancer Society’s mammography guidelines, which call for women of average risk to wait until age 45 to begin annual mammogram screenings and then move to biennial exams at age 55.

The ACS recommendations published Tuesday in the Journal of the American Medical Association appear to split the difference between its 2003 guideline, which called for annual exams beginning at 40, and those issued in 2009 by the U.S. Preventive Services Task Force and revised in April, which call for a mammogram every two years starting at age 50.

Dr. Stephen Feig, chief of breast imaging with UCI Health, says he follows the previous aggressive ACS guidelines, and will continue to recommend annual mammogram screenings for women at age 40 and every year thereafter.

“A significant number of cases are found in women between the ages of 40 and 45. If a woman doesn’t have an annual mammogram, the cancer won’t be found until it’s larger and at a later stage,” Feig says. “Don’t take a chance.”

Experts involved in both ACS and Preventative Task Force recommendations cite the risks of overdiagnosis and unnecessary procedures, which some women and physicians have come to view as dangerous as the disease itself.

The new cancer society guidelines also state that women “should have the opportunity” to consult with their doctors and make their own decisions as to what age and how often, they get screened.

What is average risk?

Feig’s colleague, Dr. Freddie Combs, director of breast imaging at UCI Health Pacific Breast Care Center, agrees on the timing.

“The American College of Radiology and the Society of Breast Imaging still recommend annual mammography beginning at age 40 and those are the guidelines I follow,” he says. “I believe there is adequate data to support that practice.”

A careful history and assessment using a validated risk assessment tool for each patient is a good starting point, Combs says, so that women can understand where they are on the risk spectrum and can make an informed decision about when to start and how often to have a mammogram.

“The breast imaging community should take a much more active role in this type of screening,” Combs says.

“As physicians who diagnose and treat breast cancer, we need to strongly emphasize risk assessment. In addition, the increased risk associated with having dense breasts needs to be taken into account and discussed with women so they understand where that places them on the risk spectrum as well.”

Feig and Combs say that risk awareness does not replace the benefit of annual screenings.

“In 80 percent of breast cancer cases, women have no risk factors, such as family history or dense breasts,” Feig says. “In terms of reducing the number of breast cancer deaths, there is more benefit in annual versus biennial mammography screening for women, beginning at age 40.”

New cancer society recommendations

According to the ACS, the following guidelines were developed to achieve a balance between the benefits and harms of mammograms, as well as to provide women with guidance and flexibility when it comes to deciding when to start and stop mammography and how frequently to be screened for breast cancer.

  • Women should undergo regular screening mammography starting at age 45.
  • Women 45 to 54 years of age should be screened annually.
  • Women 55 years and older should transition to biennial screening or have the opportunity to continue screening annually.
  • Women should have the opportunity to begin annual screening between the ages of 40 and 44 years.
  • Women should continue screening mammography as long as their overall health is good and they have a life expectancy of 10 years or longer.
  • Clinical breast examination is not recommended for breast cancer screening among average-risk women of any age.

The new guidelines were published Tuesday in the Journal of the American Medical Association. Another journal, JAMA Oncology, published a separate article and editorial on measuring the effectiveness of mammography.

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