Women ages 40 to 49 urged to consult with doctors before undergoing routine mammography

The American College of Physicians, which represents about 120,000 internists, in the April 3 issue of the Annals of Internal Medicine recommend that women ages 40 to 49 consult with their doctors about whether to undergo routine mammography screening, the Washington Post reports.

According to the group, the recommendations are based on a comprehensive review from a six-member expert panel of 117 studies conducted between 1966 and 2005, including an evaluation of the negative consequences of mammograms. The panel found that routine mammography screening might reduce the breast cancer death rate by about 15% among women in their 40s, but the data are so unclear that the rate "could be larger or nearly zero." The panel also found that routine mammograms lowered the death rate by 22% among women ages 50 and older. The possible "modest" benefit of routine mammography screening for women in their 40s must be weighed against the risk of false-positives -- which often leads to repeated exams and biopsies, causing anxiety, pain and possibly disfigurement -- the panel concluded (Stein, Washington Post, 4/3). The group recommends that younger women consider the harmful effects of mammograms and that women who decide not to undergo screening review the decision every one or two years until age 50 (Steenhuysen, Reuters, 4/3). For women at higher risk of breast cancer -- which includes women who have a family history of breast cancer, those who had their first period before age 12 and women who had their first child after age 30 -- an annual test is appropriate, the group said (Krieger, San Jose Mercury News, 4/3). According to the Post, the guidelines differ from the currently held standards established by the American Cancer Society and the National Cancer Institute, which say that women should begin having mammograms every year or two at age 40.

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"We agree that mammography can save lives," Douglas Owens, a professor medicine at Stanford University and chair of the panel that wrote the guidelines, said, adding, "But there are also potential harms. We don't think the evidence supports a blanket recommendation" (Washington Post, 4/3). Mammograms should be "tailored to a woman's situation," Owens said. According to the Mercury News, ACS criticized the guidelines, saying that they could lead to needless deaths. "If we were to screen only those women in their 40s who had significant, known risk factors, we would fail to detect the majority of breast cancers that arise during that decade of life," Robert Smith, director of cancer screening for ACS, said. He added that the guidelines represent "a step backward because it departs from the consensus in screening recommendations that has evolved through years of careful evaluations of all the scientific evidence" (San Jose Mercury News, 4/2). Russell Harris of the U.S. Preventive Services Task Force, which issues the official federal government guidelines on preventive medicine, said the guidelines are "right on target," adding, "I would like to see more women stop and think about the decision." The new guidelines come less than a week after ACS issued guidelines that recommend that women at greatest risk of breast cancer undergo magnetic resonance imaging scans annually in addition to regular mammograms (Washington Post, 4/3).

The guidelines are available online.