Mammogram Guidelines
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While two influential groups have called for women at average risk for breast cancer to begin mammogram screenings at age 45 or 50, The American Society of Breast Surgeons beg to differ, saying that the screenings should begin for most women at age 40, and that the screening should be done each year.
That makes sense to Harry Bear, a member of the society and a surgical oncologist and chair of the VCU School of Health surgery department and director of the breast health program at VCU Massey Cancer Center.
The guidelines are simple and straightforward, perfect for both patient and her doctor to remember. It’s hard to keep track of when a procedure is due on such a timescale.
“None of these people are experts on breast cancer, they just want some guidelines to help them take care of patients and make sure they are being cared for by evidence-based screening,” he says.
The American Society of Breast Surgeons issued a position statement on screening guidelines on May 3. It’s recommendations include yearly mammography for a woman 40 or older, and a breast cancer risk assessment for women 25 and older. Those at a higher risk for breast cancer should receive annual mammography and also should be offered a supplemental imaging screening each year. For example, those with a lifetime predicted risk greater than 20 percent or a strong family history of the disease should start mammography screening at age 35, and also have the option for a supplemental screening such as by MRI if recommended by their doctor. Some women at greater risk should begin screening at age 30 under the breast surgeons society recommendations.
The U.S. Preventive Services Task Force says it should be an individual decision in women ages 40 to 49 on when they begin mammography screening. The task force says that for women in their 40s, there is a greater chance of unnecessary biopsies and false positives, and also a greater risk of over-diagnosis, which results in over-treatment for cancers that would not otherwise cause a problem.
The task force says that most women ages 50 to 74 should receive mammography screening every other year. Data shows that women in the 60s are the most likely age to benefit from biennial screening in terms of deaths prevented.
The American Cancer Society calls for yearly mammograms for women ages 45 to 54, and screenings every other year for women 55 and older. The cancer society says that women ages 40 to 44 should have the option to begin annual mammograms at their choice.
Massey Cancer Center notes in a release that the recommendations differ because of the models on which they are based. The task force and cancer society use a model that weighs the cost of screening and the risk of false positives, while the breast surgeons society model takes into account survival attributed to early detection. The breast surgeon society report cites that screening results in a 15 percent reduction in breast cancer mortality in women in their 40s. Overall, 12 percent of American women develop breast cancer at some point in life, about 1 in 8 women.
