Latest Mammogram Screening Guidelines
Should women start mammograms at 40? Or wait till 50? New USPSTF recommendations question early breast cancer screening.
The new U.S. Preventive Services Task Force (USPSTF) recommendations on when to begin and end mammogram screening have many women wondering how the news affects their personal breast-care decisions. There isn't an easy answer.
Here is what's changed. Previously, the USPSTF recommended that women in their 40s with an average risk of breast cancer get a mammogram every year or two. And that women age 50 and up get one yearly.
Now, the task force recommends against screening for most women in their 40s and advises that women 50 to 74 get a mammogram every two years instead of every one. It also recommends that screening stop at age 74. Why? Here's how RealAge experts Mehmet Oz, MD, and Michael Roizen, MD, summarize the group's thinking:
"For starters, screening younger women hasn't dramatically increased the number of lives saved. While mammograms have reduced the risk of breast-cancer deaths overall by about 15%, that risk is so low in women under age 50 that the screenings don't save significantly more lives. Research cited by the task force estimates that to spare the life of one woman in her 40s, 1,904 women would need one mammogram every year for ten years. In contrast, one life is saved for every 1,339 women in their 50s who get ten years' worth of checks and one life for every 377 women in their 60s.
"Mammograms are far from perfect, too. Younger women have a 1 in 10 chance of a false alarm -- suspicious findings that are scary and trigger more tests that are expensive, time consuming, and sometimes uncomfortable, yet turn out not to find cancer. About half of women in their 40s will have a false positive by the time they've had 10 mammograms.
"Mammograms can also miss aggressive, fast-growing cancers and have trouble spotting problems in dense breast tissue, and both challenges are more common in younger women. In addition, about 1 in 3 cancers detected by mammograms may be so slow-growing that they'll never be a problem. But 2 in 3 aren't, so you see why there's no easy answer here."
Thanks, Drs. Oz and Roizen. Nicely put. So here are several things you should know as you figure out what the new recommendations mean for you:
First, although the USPSTF is influential -- the recommendations of its independent panel of medical experts often sway doctors and insurance companies -- this group doesn't, by itself, change the rules. So how its recent shift will play out in your doctor's office or whether it will affect your insurance provider has yet to be seen.
Second, many groups -- including the American Cancer Society and the American College of Obstetricians and Gynecologists -- are sticking with the traditional advice: Start yearly screening at 40.
Third, know that your decision to screen or not to screen will involve more than statistics. And the point isn't that younger women's lives are less valuable; it's that mammograms aren't perfect for women in that group.
Finally, some things haven't changed -- and shouldn't. Women at high risk due to family history or genetics are still urged to start earlier than 40 and sometimes to get more frequent checks. And if you have a personal history of breast cancer, you should continue to follow your doctor's screening recommendations.
So every woman is different in terms of where she fits into this picture, as well as how she feels about these realities. What you feel comfortable with depends on you. Discuss your unique needs with your doctor, and while you're at it, talk over the value of doing breast self-exams. Although the task force also suggested that monthly breast checks don't save lives, Drs. Oz and Roizen think that "getting to know what's normal there, and what's not, is a good idea." If you decide to do self-exams, learn how to do them right.
In the meantime, know that insurance coverage for annual mammograms won't change -- at least not right away. In most states, regular screenings for women 40 and up are mandated by law and would have to be changed by state legislatures. It's not clear if that will or won't happen. But if it does, it is likely to be a very slow process. Think snails.
