Panel: Mammograms Should Start At 50, Not 40

A panel of experts says mammograms are causing women being screened for breast cancer to have too many false alarms and unneeded biopsies. The panel is recommending that women wait until 50 to get mammograms and then only every two years. The American Cancer Society says it stands by its recommendations of regular mammograms beginning at age 40.

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STEVE INSKEEP, host:

Its MORNING EDITION from NPR News. Renee Montagne is away today. Im Steve Inskeep.

Women can wait until theyre 50 to start getting mammograms. That is not the advice we were hearing; it is the new recommendation by a group of doctors that advises the federal government. The same U.S. preventive services task force offered different guidance just a few years ago. Back then, it said that women should be screened every year or two after age 40. NPRs Brenda Wilson tells us why they changed their view.

BRENDA WILSON: The task force is recommending against routine mammography screening for women age 40. If women want to be screened every other year on a regular basis before they turn 50 its an individual patients decision. This applies only to women who have no other risk factors for breast cancer.

The recommendation was guided by researchers like Dr. Jeanneļæ½Mandelblatt of Georgetown University, who found that while screening early saves more lives it has to be counterbalanced by the harm thats done.

Dr. JEANNEļæ½MANDELBLATT (Georgetown University): The harms that we considered included having a false positive mammogram, suggesting a woman might have cancer but it turns out she does not. A woman might undergo a biopsy for an abnormal mammogram and undergo the stress and worry about that and turn out to not have cancer. A woman would be diagnosed with a small early tumor that would never have harmed her.

WILSON: If a woman starts screening at age 40 compared to age 50 she says youd save one more life for every 1,000 women screened, and nearly half of those women, 470 of them, would have an abnormal mammogram.

But many find these concerns misleading, including the American Cancer Society and American College of Obstetricians and Gynecologists. Dr. Constance Lehman chairs the American College of Radiology.

Dr. CONSTANCE LEHMAN (Vice chair, American College of Radiology): This is a very serious concern we have in women being mis-educated about the importance of early detection. In fact, Ive had women in our clinic who were successfully treated of an invasive breast cancer wonder if they shouldve left it alone and not be treated because it would never have progressed to a cancer that could actually take her life.

WILSON: Not all cancers become invasive. But there are others, she says, which a mammogram may pick up before its at an advanced stage. Thats more likely to happen, she says, if a woman is screened every year.

Dr. LEHMAN: It will put them in a group of women where they more likely can have their breasts conserved. Without that early detection, theyre much more likely to be told they need to have the breast removed and that they will need more aggressive treatment with radiation and chemotherapy.

WILSON: She says, increasingly, younger women and African-American women are developing aggressive cancers that will not be detected if they are only screened every other year.

Dr. Susan Love, a breast cancer researcher who supports the new guidelines.

Dr. SUSAN LOVE (Dr. Susan Love Research Foundation): Theres no data to suggest that mammography screening will be able to reduce this. What we really need is to figure out whats causing breast cancer in these young women and figure out a way to stop it.

WILSON: Love wants more money for research and says the task force position needs to be kept in perspective.

Dr. LOVE: This is weighing overall risks versus benefits and saying, as a public policy, its not worth it to do screening of women under 50. And thats different than when you're, one by one, seeing patients.

WILSON: Ultimately, that means women will be guided by a conversation with their doctor and who is paying for it. The worry is that the new recommendations will send a signal to insurance companies to deny coverage for younger women who want to be screened.

Brenda Wilson, NPR News.

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