New U.S. mammogram guidelines stick with screening from age 50

Reuters News
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Posted: Apr 20, 2015 6:50 PM

By Julie Steenhuysen

CHICAGO (Reuters) - New mammogram screening guidelines from an influential panel of U.S. experts reaffirm earlier guidance that breast cancer screening should begin at age 50 for most women, but they acknowledge that women in their 40s also benefit, something experts say is a step in the right direction.

"They made it really clear this time around, unlike 2009, that the discussion between a woman and a clinician about breast cancer screening should begin at 40," said Dr. Richard Wender, chief cancer control officer at the American Cancer Society.

The Department of Health and Human Services provided for mammogram coverage for women age 40 to 49 after the health panel made its recommendation in 2009. The department said on Monday that the guidelines are only in draft form and that nothing has changed regarding access to mammograms or other preventive services.

Critics stressed that keeping 50 as the starting age for screening – a change first introduced by the panel six years ago - could threaten insurance coverage for millions of women age 40 to 49.

"If this becomes the final guideline, coverage of mammograms would no longer be mandated under the ACA," said Wender.

President Barack Obama's Affordable Care Act (ACA) requires preventive medical services with a grade of "B" or higher be covered, unless the administration specifies otherwise.

Under the draft guidelines released on Monday, mammogram screening every two years for women 50 to 74 got a grade of "B", meaning doctors should offer the service. Screening for women in their 40s remained a "C" grade, meaning doctors should offer the service for select patients, depending on individual circumstances.

The draft guidelines from the government-backed U.S. Preventive Services Task Force also prompted renewed debate over when women should be screened for breast cancer, as patients parse conflicting advice from health experts and advocacy groups.

Some prominent physician groups welcomed the shift in the panel's language after its abrupt change in screening recommendations in 2009, in which it recommended women should have mammograms every other year starting at age 50 rather than annual tests starting at age 40.

Many groups including the American College of Obstetricians and Gynecologists (ACOG) and the American College of Radiology recommend annual mammograms start at age 40. The American Cancer Society shares that view, but is reviewing its guidelines.

The health panel's updated recommendations are now "more closely in line with ACOG’s," said Dr. John Jennings, ACOG president. Both groups recognize that the decision to screen women in their 40s is a personal one that reflects potential benefits of detecting cancer early and the harm of receiving a false positive, he said.

WEIGHING THE EVIDENCE

The new health panel guidelines are based on a review of scientific evidence showing the benefits of cancer screening outweigh the risk of overtreatment for women age 50 to 74.

They acknowledge that mammograms in women 40 to 49 may reduce the risk of dying of breast cancer, but say that the number of deaths averted is "much smaller" and the "number of false-positive tests and unnecessary biopsies are larger."

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 value of mammography increases with age," said Task Force chair Dr. Michael LeFevre, a professor of family medicine at the University of Missouri School of Medicine.

Dr. Daniel Kopans, a professor of radiology at Harvard Medical School, said the task force should still emphasize the potential for saving lives by beginning screening at age 40.

"They should support screening annually beginning at the age of 40 while providing women with accurate, scientifically derived information so that each woman (not the panel) can decide for herself whether or not to participate in screening," Kopans said in a written statement.

The panel's review included clinical trials that showed over a 10-year period, mammography prevents four deaths per 10,000 women age 40 to 49 years, five to eight deaths for women age 50 to 59, and 12 to 21 deaths for women age 60 to 69.

The panel also considered new simulation models from six independent research teams that analyzed data from digital mammograms, the cost commonly used technology.

That modeling unanimously projected that screening every two years from age 50 to 74 would, over a lifetime, prevent seven breast cancer deaths per 1,000 women screened. Starting screening every two years from age 40 would prevent one more death from breast cancer and generate 576 more false positive tests.

(This version of the story corrects the name of the physician group in paragraph 10 to 'American College of Obstetricians and Gynecologists' from 'the American College of Obstetrics and Gynecology')

(Reporting by Julie Steenhuysen; Editing by Michele Gershberg and Lisa Shumaker)