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