New Guidelines Raise Recommended Age To Begin Mammograms
New guidelines from the U.S. Preventive Services Task Force recommend that most women begin routine breast cancer screening with mammograms at age 50, not age 40 as previous recommendations stated, the New York Times reports (Kolata, New York Times, 11/17).
The task force -- comprised of an independent panel of experts on primary care and prevention appointed by HHS -- also said that:
- Women between the ages 50 and 74 should receive mammograms every other year, not annually;
- Doctors should not instruct women how to examine their breasts on a regular basis; and
- There was insufficient data concerning the benefits of screening after age 74 (Wilson, "All Things Considered," NPR, 11/17).
These guidelines do not apply to women who face a higher risk of breast cancer based on family history or the presence of genetic mutations -- such as the BRCA1 or BRCA2 genes -- linked to the disease.
Experts Found Costs of Early Mammograms Outweighed Benefits
The task force issued its recommendations after reviewing research published since it last issued breast cancer screening guidelines in 2002. It also considered new analyses of the data (Wang, Wall Street Journal, 11/17).
In setting the new guidelines, the experts weighed the benefits of early screening against the risks -- namely the high chance that a mammogram could result in a "false positive" for women, creating undue stress and anxiety, and prompting additional and unnecessary treatments.
According to the research, women in their 40's are 60% more likely to experience negative effects from mammograms than women older than age 50 and yet are much less likely to have breast cancer (Kolata, New York Times, 11/17).
The research found that less frequent screening maintains 81% of the benefits of annual testing but reduces the risks of false-positives by 50% (Stein, Washington Post, 11/17).
The researchers also found that the 10-year breast cancer risk for women age 40 is 1.4% and that annual mammograms resulted in only a slight reduction of death for women that age (Szabo, USA Today, 11/17).
The researchers found that for women ages 40 to 49 screened annually, one cancer death is prevented for every 1,904 women screened.
For women ages 50 to 74, the ratio is one death prevented for every 1,339 women screened, and the ratio for women ages 60 to 69 is one death prevented for every 377 women screened (Kolata, New York Times, 11/17).
Researchers also said that self-examinations did not reduce breast cancer death rates ("All Things Considered," NPR, 11/17).
Potential Effect on Coverage
CMS said that the new guidelines would not alter how Medicare or Medicaid cover mammograms (Wall Street Journal, 11/17). Congress currently requires Medicare to cover annual mammograms.
The effect of the new guidelines on private insurers is less clear.
According to the Times, the new recommendations are not expected to have an immediate effect on coverage, because every state except Utah currently mandates that private insurers pay for mammograms for women in their 40's (Kolata, New York Times, 11/17).
However, Susan Pisano, a spokesperson for America's Health Insurance Plans, said that insurers might change their aggressive outreach efforts aimed at getting younger women to undergo breast cancer screenings (Wall Street Journal, 11/17).
New Guidelines Draw Opposition From Some Groups
While some advocacy groups were receptive to the new guidelines, other considered them misguided and potentially dangerous, the New York Times reports (Rabin, New York Times, 11/17).
Some groups that issue guidelines on screening and cancer prevention criticized the task force's recommendations.The American Cancer Society and the American College of Obstetricians and Gynecologists said their guidelines would remain intact despite the new research (Graham/Maugh, Los Angeles Times, 11/17). This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.