The American Cancer Society on Tuesday, Oct. 20, announced new guidelines for mammograms, recommending that women with an average risk of breast cancer begin getting mammograms annually at age 45.
The organization, which has long taken an aggressive approach to screening for the condition, also recommended that once women reach the age of 55, mammograms continue once every other year. Additionally, the society no longer recommends clinical breast exams for breast cancer screening among average-risk women at any age, as these have not been shown to save lives.
The society’s new guidelines, published in the Journal of the American Medical Association, come after it thoroughly examined research data questioning the benefit of yearly mammograms for women in their 40s.
“We’re moving to an era where people are recognizing the limitations of screening tests,” said Dr. Nancy Keating, professor of health care policy and medicine at Harvard Medical School who wrote an editorial accompanying the new recommendations. “For many years, we convinced everybody, including doctors, that mammograms are the best tests and everyone has to have one. But now we’re acknowledging that the benefits are modest and the harms are real.”
The recommendations only apply to women who have no personal history of the condition or known risk factors based on family history, genetic mutations or other medical problems. Women who have a genetic risk for the condition are advised to begin undergoing the exam sooner.
The move reflects shifting attitudes in cancer screening. Six years ago, the cancer society spoke out against a federal task force that suggested most women could wait until the age of 50 to begin screening for breast cancer. They said postponing mammograms would result in increased deaths among women.
“Despite some face validity in the idea that younger women, who often have more aggressive cancers, might benefit from shorter screening intervals, the actual clinical effects and importance remain uncertain,” Keating wrote in an editorial.
Breast cancer is among the top killers of American women. This year, more than 200,000 new cases are predicted and more than 40,000 deaths as a result are expected in the United States.
The society said it set changed its recommendation for annual mammograms at age 45 because that’s when a woman’s risk for breast cancer spikes. By the time women reach age 55, when most have passed menopause, tumors are usually less aggressive and grow at a slower rate. Additionally, changes in breast tissue make it easier to read mammograms.
Overdiagnosis was another result of mammograms that researchers in a separate study found, which means women received unnecessary treatment and procedures, and underwent emotional distress. Younger women have more dense breast tissue and mammograms beginning at age 40 could result in false positives. One study revealed that a number of women suffer intense anguish after being called for a follow-up mammogram because a radiologist saw something suspicious, NBC News reported.
Most women overestimate how much mammograms actually help, Lisa Schwarts, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice in New Hampshire, told NBC News. The exams decrease the risk of death from breast cancer by anywhere between 15 percent to 40 percent, depending on studies considered.
“About 85 [percent] of women in their 40s and 50s who die of breast cancer would have died regardless of mammography screening,” Keating said. “More sophisticated screening tests that confer a greater reduction in breast cancer mortality would likely decrease breast cancer mortality much more than expanding screening mammography for women in their 40s and 50s.”
Wender said he hoped the changes would put an end to debates and confusion about mammography, The New York Times reported, but others doubt they would bring clarity.
“I think it has the potential to create a lot of confusion amongst women and primary care providers,” Dr. Therese Bevers, medical director of the Cancer Prevention Center at the University of Texas M.D. Anderson Cancer Center in Houston, told the Times.
Other groups still recommend that women begin undergoing mammograms earlier, including the National Comprehensive Cancer Network, which suggests annual mammograms begin at age 40. Similarly, the American College of Obstetricians and Gynecologists recommends the test every one to two years between the ages of 40 to 49, and once per year after that. Furthermore, it suggests annual clinical breasts exams starting at age 19.
But the most important thing, most groups agree, is that women to discuss their risk for breast cancer with their doctors and decide what she’s most comfortable doing, according to NBC News.
“A woman should make a personal decision as whether she should start screening before age 45 but we clearly recommend that by age 45 all women should start regular screening every year,” Wender told NBC News.
