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The question isn't "Should I get a mammogram?" but "When?" - Update on mammography guidelines

October 21, 2015

It’s been nearly two years since the U.S. Preventive Services Task Force (USPSTF) sparked a vigorous debate among patients and health care professionals after issuing their controversial recommendations in November 2009 to roll back breast screening guidelines.

The USPSTF recommended against routine mammograms for women in their 40s and suggested women in their 50s only get mammograms every other year as opposed to annually.

Now, six years later, the American Cancer Society announced that they are changing their recommendations, moving closer to the recommendation of the USPSTF, noting women should begin annual breast cancer screenings at age 45.

40? 45? 50?

What’s a woman to think?

The question is not 'do I need a mammogram?'.

“Mammography is still the best screening tool for breast cancer and screening saves lives,” said Dr. Nikolaus Kashey, medical director of Population Health at Baystate Health.

The question is at what age to begin regular screening, and how frequently.

“It’s important to remember these newer screening guidelines are for average risk women only,” said Dr. Kashey, who helped to establish Baystate Health’s Clinical Practice Guidelines for Screening Mammography. “Women who are at high risk for breast cancer based on family or personal history are excluded from these recommendations.”

Clinical Practice Guidelines for Screening Mammography 

"Baystate Health recognizes that the different national guidelines vary in their recommendations, and we feel that the decision of when to start screening should be made between a woman and her provider after a discussion of the risks and benefits involved," said Dr. Kashey.

Baystate’s minimum standard for mammography is to assess risk and engage in a discussion about screening options with women starting at 40, and at a minimum recommend screening every 2 years for women ages 50-74. Starting mammography earlier or being screened each year and continuing screening beyond age 74, is “at the discretion of the doctor and patient.”

“Basically, what we are saying is that women need to have a discussion with their doctors early on about when to begin screening mammography,” said Dr. Kashey.

“This is shared decision making between a woman and her doctor,” he added.

Dr. Kashey reiterated that everyone agrees that mammograms should begin no later than 50 and performed at a minimum of two-year intervals, while ACS is still saying every year from 45- 55.

“The variability between national guidelines remains between ages 40-50,” he said.

The newer guidelines are a reflection that the medical community is recognizing that although some women have benefited from early detection of breast cancer with mammography, there are also harms associated with early and frequent routine screening that can also result in overdiagnosis and overtreatment.

Despite the benefits, there is also risk involved in testing, noted Dr. Kashey.

“The risk of false positives can lead to additional testing and unnecessary biopsies, while the concept of overdiagnosis implies our finding a tumor that may never cause harm to a woman. Some findings on mammography are treated as cancer, because we don’t currently have the ability to distinguish the tumors that will be more aggressive from those that may not need treatment and not cause health problems. We need ongoing research to help us determine how to best manage these findings," he said.