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Radiologists Strike Back: Mammograms Should Start At 40

The folks who read mammograms for a living say they know best about their value in detecting breast cancer. Their advice to women: start at age 40 and get a mammogram every year. For women with a particularly high risk for breast cancer, annual mammograms should start by age 30 but not before 25.

Breast cancer shows up on a mammogram.

The white arrow points out cancer in this mammogram. NIH via Wikimedia Commons hide caption

itoggle caption NIH via Wikimedia Commons

Those recommendations, published in the current issue of the Journal of the American College of Radiology, are at odds with controversial advice by the U.S. Preventive Services Task Force that women put off mammograms until age 50 and even then just get them every two years, in most cases.

One of the authors of the radiologists' guidelines is Dr. Daniel Kopans, a professor of radiology at Harvard and longtime advocate for mammography, who minced no words in explaining the differences:

The American College of Radiology is driven by the science and the evidence and the USPTF ignored the evidence.

He says the federal task force didn't pay enough attention to the results of studies that show routine mammography is a major reason for a nearly 30 percent drop in breast cancer death rates since 1990. Research in the Netherlands and Sweden, he says, makes the case.

The radiologists have another beef: picking age 50 as a dividing line for screening frequency. Kopans said that age is essentially arbitrary. Grouping data along arbitrary age lines, Kopans argues, makes it look as though breast cancer risk jumps starting at 50, when, in fact, it rises steadily with age.

What about the apparent conflicts of radiologists recommending more radiology? "I earn my living reading mammograms," Kopans says. "But if you don't have a conflict of interest you probably don't have the expertise." The USPTF panel didn't include any radiologists, a fact that drew fire at a House hearing on the mammography guidelines last month.

In prepared testimony, USPTF representatives said the screening recommendations had been poorly communicated. What did they mean to say? Try this:

[T]he decision to have a mammogram for women in their 40s should be based on a discussion between a women her doctor. Many doctors and many women, perhaps even most women, will decide to have mammography screening starting at age 40. The Task Force supports those decisions.

We called the Agency for Healthcare Research and Quality, the federal agency that supports the USPSTF, for comment on the radiologists' recommendation but didn't hear back immediately.

A summary of the radiologists' advice is here. For more on alternatives to mammograms, see this interview with Dr. Carol Lee, lead author of the radiologists guidelines.



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