Mammogram Redux

In a dramatic reversal, new guidelines released this week suggest women start getting mammograms at the age of 50 and not 40, as previously suggested.

The new recommendations were put forth by the United States Preventive Services Task Force, an influential group that offers guidance to doctors, insurance companies and policy makers.

Just seven years ago, that very same group recommended that women start regular breast cancer screening at 40 — a practice that has been widely adopted, with two thirds of women in their 40s getting the screens in the past two years, according to the New York Times.

The group is also reversing recommendations on the frequency of mammograms, saying women only need the screens every two years between the ages of 50 and 74, rather than every year. It also suggests that doctors stop teaching women about breast self-examination. (Of course, the new recommendations do not apply to those at an elevated risk due to family history of breast cancer, gene mutation, and/or exposure to chest radiation.)

So, what's going on here? Is this good news or what?

It's hard to tell at this point. The task force, which is an independent panel of experts appointed by the federal Department of Health and Human Services, told the New York Times that the guidelines were based on new data and analyses that showed that the risks of the screens outweighed the benefits.

Medical experts say that while mammograms themselves aren't harmful, they can lead to further tests, such as biopsies, which can cause anxiety and unnecessary treatment. For example, the mammograms can pick up cancers that grow so slowly they would never be noticed in a woman's lifetime.

Currently, mammograms are credited with reducing breast cancer death by 15 percent among all women. But the numbers show that just one cancer death is prevented for every 1,904 women in their 40s screened every 10 years, according to the Times article. The prevention numbers increase dramatically with age, with one death prevented for every 377 women in their 60s.

Reaction in the health care and cancer communities has been mixed. The National Cancer Institute said it would re-evaluate its guidelines in light of the report. The National Breast Cancer Coalition, Breast Cancer Action, and the National Women’s Health Network, all welcomed the new guidelines as well.

But the American Cancer Society and the American College of Radiology don't plan on changing their recommendations.

It's unclear whether the guidelines will immediately impact insurance coverage. Private insurers are required in every state except Utah to cover mammograms from the age of 40 onwards.

Photo courtesy of musiclver05 via Flickr.