ACOG calls for annual mammograms for women starting at age 40

The recommendations mark a departure from the group's previous guidelines and differ from those of the U.S. Preventive Services Task Force.

By — Posted Aug. 1, 2011

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Amid conflicting opinions on how often women should receive mammograms, the nation's largest ob-gyn organization has issued new guidance urging physicians to screen their female patients more frequently.

The American College of Obstetricians and Gynecologists released a practice bulletin July 20 recommending that doctors offer mammograms annually to women beginning at age 40. The recommendations were published in the August issue of Obstetrics and Gynecology.

The new guidelines mark a departure from ACOG's previous position that screening be conducted every one to two years for all women starting at age 40 and annually beginning at age 50.

The revision is in line with the American Cancer Society's guidelines. The U.S. Preventive Services Task Force, however, recommends against annual mammography for women younger than 50. Instead, the organization suggests biennial mammograms for women 50 to 74.

The task force said the benefits of regular mammography for patients in their 40s are small in relation to the harms. Such potential harms include false-positive results, patient anxiety due to screening, unnecessary biopsies, discomfort during mammograms and radiation exposure.

"We know that it's been, at times, confusing for providers and patients to try to understand why different people arrived at different decisions essentially using the same evidence pool," said Jennifer Griffin, MD, MPH, a co-author of the guidelines and assistant professor in the Dept. of Obstetrics and Gynecology at the University of Nebraska Medical Center.

Quicker growth in younger women

She said ACOG's new recommendation is based, in large part, on the sojourn time for breast cancer growth, or the period when cancer can be detected by a mammogram but still is too small to be symptomatic. Breast cancer tends to grow more quickly in young women than in older ones, according to ACOG.

Tumors identified at an early stage that are small and confined to the breast are more likely to be treated successfully, the guideline authors said. In fact, studies show that 90% of patients whose tumors measured 1 cm or less when they were detected by mammography were disease-free for at least 10 years.

"If women in their 40s have annual mammograms, there is a better chance of detecting and treating the cancer before it has time to spread than if they wait two years between mammograms," Dr. Griffin said.

Early detection is partially credited for the steadily falling breast cancer death rate among women younger than 50, according to the American Cancer Society. Since 1990, the breast cancer death rate for women in that age group has decreased by 3.2% annually.

Susan G. Komen for the Cure, the world's largest breast cancer organization, applauded ACOG's new mammography screening guidance. "This recommendation reaffirms what we have been saying for many years -- that women in their 40s should get mammograms because early detection saves lives," said Nancy G. Brinker, founder and CEO of Susan G. Komen for the Cure.

Breast cancer prevalence

Breast cancer is the second most frequently diagnosed cancer in women after skin cancer, according to the cancer society. More than 280,000 new cases are expected to occur among U.S. women in 2011. Of those women, an estimated 39,520 will die of the disease.

To help detect the condition early, ACOG continues to recommend annual clinical breast exams for women 40 and older. Physicians should conduct the exam every one to three years for female patients 20 to 39. Physicians should encourage women to be aware of changes in their breasts and to bring abnormalities to their attention.

"Although we've moved away from routinely recommending [breast self-exams], some women will want to continue doing them, and that's OK," Dr. Griffin said.

There is no consensus on the upper age limit for mammograms, although benefits of screening decline with increasing age, ACOG said. Women 75 and older should discuss with their physician whether to continue getting mammograms, Dr. Griffin said.

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External links

Details on "Practice Bulletin No. 122: Breast Cancer Screening," American College of Obstetricians and Gynecologists, July 20 (link)

"Screening for Breast Cancer," U.S. Preventive Services Task Force, December 2009 (link)

Centers for Disease Control and Prevention on breast cancer (link)

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