New recommendations for Screening Mammography

Recently the US Preventive Services Task Force, an independent panel of primary care physicians funded by the Health and Human Services Agency for Healthcare Research and Quality, submitted new recommendations for screening mammography in the general population. These new recommendations have been given much media attention in recent days
which has resulted in widespread confusion and uncertainty because they appear to contradict the well-established guidelines for screening.

The current guidelines, which were endorsed by the same task force in 2002, recommend starting yearly screening mammograms at age 40 with no upper limit on age. The Task Force looked at large populations of women and analyzed the incidence of breast cancer in each decade, the relative effect of detection on overall survival, and potential negative consequences of screening to create the new guidelines, which recommend beginning routine screening mammography at age 50 and continue every other year until age 74. The new guidelines recommend against routine screening in women age 40-49 and over the age of 75, except in the case of patients considered “high risk”.

While this is an important study, we need to keep in mind that it is only one of a number of studies, several of which have arrived at very different conclusions. For example, recent studies from the Netherlands and Sweden show that early screening mammography results in a decrease in deaths of over 40% in women in their 40’s. By limiting screening mammograms in women 40-49 to only those who are considered “high risk”, the USPSTF study ignores the fact that 75% of breast cancers occur in women without risk factors.

The American Cancer Society, The American College of Obstetrics and Gynecology, the Susan B Komen Foundation, and the American College of Radiology have all issued statements saying that they support the current recommendation that women begin annual screening mammograms at age 40. Medicare, as well as all of the major insurance companies have said that they have no immediate plans to change their reimbursement for screening mammograms for women of any age.

Vancouver Radiologists remains deeply committed to women’s health and breast care issues. Until there is a new consensus in the scientific community on this issue, we believe it is in the patients’ best interest to continue to recommend annual routine mammograms for all women over the age of 40. Instead of this being a divisive and confusing time, we see these developments as an opportunity for patients to begin a dialog with their primary care physicians on this and other issues.

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