MAMMOGRAMS: AMA’s New Advice is Annual Test at Age 40
Shifting its stance in tune with "a growing chorus" of medical opinion, the American Medical Association recommended yesterday that all women undergo annual mammograms beginning at age 40, the Wall Street Journal reports. Previously, it recommended occasional mammograms between age 40 and 50 and annual tests beginning at 50. In recent years, "conflicting recommendations from professional bodies and government agencies ... have proven contentious in the medical community and confusing for the public." After a government panel "provoked a firestorm" when it found no benefit for mammograms for women in their 40s, the National Cancer Institute quickly revisited the issue and now urges mammograms once every one to two years for women in their 40s. The AMA's policy shift from age 50 to 40 is in line with recommendations from the American Cancer Society, the American College of Radiology and "leading breast cancer advocacy organizations" (Jeffrey, 6/25). The change, however, pits the AMA against the government and the American College of Obstetricians and Gynecologists, which both advocate two-year testing.
The AMA's 494-member House of Delegates heard from advocates on both sides of the issue yesterday at its annual policy meeting. American College of Surgeons spokesperson Richard Reiling said, "One in six breast cancer deaths in 1995 were attributable to women diagnosed with breast cancer during their 40s." On the other hand, Dr. Scott Karlan of the American Society of General Surgeons pointed to a decade-long study of 25,000 Canadian women that found no benefit to the earlier mammograms. "Even the studies that have been in favor of mammography have pointed out that the incidence of breast cancer is so low, and the sensitivity of mammography is so low in women between the ages of 40 and 50, that you would have to screen more than 250,000 women to find, perhaps, one curable case," he said (Coleman, AP/Philadelphia Inquirer, 6/25). Some insurers point to such evidence to bolster their claims that women in their 40s should undergo screening once every two years, and then annually after age 50. This practice is "unlikely to change unless the AMA has uncovered new evidence supporting a change," said American Association of Health Plans spokesperson Susan Pisano (Journal, 6/25).