Women in their 40s at average risk for breast cancer should talk to their healthcare provider about the risks and benefits of mammography before starting regular screening at that age, according to guidelines released Thursday by the American College of Obstetricians and Gynecologists.
The group has previously recommended annual mammograms starting at age 40. But the advice has changed to better incorporate input from the woman being screened, says physician Christopher Zahn, vice president of practice activities at ACOG. “A patient’s preferences and values need to be an important part” of the decision, he says.
Now the group says providers should offer the test when a woman enters her 40s, and that after a discussion, she may opt to start screening. If she doesn’t, she should start by age 50, ACOG says. Zahn says the guidance intentionally encompasses advice from other major groups.
The U.S. Preventive Services Task Force says women should start regular mammograms at 50, and that women in their 40s should make an individual decision about whether or not to screen. The American Cancer Society says screening should be offered to start at age 40, and outright recommends starting at 45. And the National Comprehensive Cancer Network, an alliance of major cancer centers, recommends starting at 40.
The question all these groups have wrestled with is how to balance the benefits and harms of mammography; their different recommendations reflect differences in how they interpreted and weighed the available data. “All three [schedules] are reasonable approaches to take,” says Zahn.
Mammography clearly saves lives for women over 50 and likely does so overall for women in their 40s, says Otis Brawley, the chief medical officer at the American Cancer Society. But the benefits in those younger women are smaller, and they come at the cost of false alarms, unnecessary biopsies and overdiagnosis when cancer that is detected and treated never would have threatened a woman’s health had it gone undiscovered. (The ACS says estimates of overdiagnosis vary widely, from 0 percent to 54 percent of breast cancers, in part depending on whether cases of ductal carcinoma in situ – abnormal cells that sometimes turn into cancer – are included.)
Once a woman starts mammography, she can be screened every one or two years, again after a discussion about the pros and cons of the different schedules, ACOG advises. The American Cancer Society recommends annual screening for women through age 54 and every other year for older women, with the option to continue annual tests, while USPSTF says every other year is sufficient and the network of cancer centers recommends annual screening.
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