A Mammogram at Age 50 or 40? The Debate Continues

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Six years ago a federal panel of medical experts said women didn’t need to start getting routine mammograms until they were 50 — not 40, as other medical groups had long advised — and then only every two years.

The announcement set off a heated debate, and most older women ended up ignoring the advice.

This week, the panel released a proposed updated version of those 2009 recommendations, and not much has changed. Including the debate.

The panel, the U.S. Preventive Services Task Force, still recommends that women wait until age 50 to start regular mammograms, noting that they’re most beneficial for women ages 50 to 74, with women 60 to 69 “most likely to avoid a breast cancer death through mammography screening.”

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As for women in their 40s, the panel reiterates that there is much less benefit for that age group to be regularly screened but clarifies that it should be an "individual decision" — meaning women younger than 50 should weigh factors such as family history, as well as the risks of overtreatment.

“Women with a parent, sibling or child with breast cancer may benefit more than average-risk women from beginning screening between the ages of 40 and 49 years,” the report said.

Even so, the panel is sticking with its prior controversial recommendation that women age 50 or older don’t need annual mammograms; every two years is enough.

“We do recognize that mammography is an important tool to reduce the number of women dying of breast cancer, and we know that value increases as a woman ages,” the task force’s immediate past chair, Michael LeFevre, M.D., said in an interview.

But he also stressed that more frequent screening “doesn’t come without harms,” including unneeded invasive biopsies and overtreatment of tiny tumors that would not have harmed a woman’s health. “For every death averted by a mammogram diagnosis, two women are treated unnecessarily,” he said.

Not surprisingly, there was strong disagreement with the panel’s proposed recommendations, including from the American College of Radiology, which said in a statement that the guidelines  “would result in thousands of additional and unnecessary breast cancer deaths each year.”

Florida congresswoman and breast cancer survivor Debbie Wasserman Schulz, writing in the Washington Post, said the recommendations "could lead to insurance companies dropping coverage of mammograms for women under age 50, as well as other preventive techniques that would help protect young women from getting breast cancer and help those who do have it."

Wasserman Schulz, who has undergone seven breast cancer surgeries, called the task force's guidelines "a wrong and dangerous path to take."

The task force “has done a disservice to women,” Laurie Margolies, M.D., director of breast imaging at Mount Sinai Hospital in New York, said in an email. She faulted the panel for its concern that too-frequent screening might lead to women being treated for tiny, harmless tumors.

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“We don’t know whose cancer will be slow-growing or aggressive. Therefore, we must screen all women so no one dies unnecessarily from breast cancer. That is a cost that society should bear,” she said.

Recommendations aside, LeFevre, a family physician and vice chair of family and community medicine at the University of Missouri in Columbia, said he still stresses the value of mammograms to his older women patients: “Women in their 40s, I say I would like to talk to them about mammography. If they’re age 50 to 74, I say I recommend we do a mammogram.”

The task force also found insufficient evidence to make a recommendation for or against 3-D mammograms, a promising new technology. The benefits of mammograms for women 75 or older were also unclear because of inadequate research, the task force reported.

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