New advice: Skip mammograms in 40s, start at 50.

NEW YORK – Most women don't need a mammogram in their 40s and should get one every two years starting at 50, a government task force said Monday. It's a major reversal that conflicts with the American Cancer Society's long-standing position.

Also, the task force said breast self-exams do no good and women shouldn't be taught to do them.

For most of the past two decades, the cancer society has been recommending annual mammograms beginning at 40.

But the government panel of doctors and scientists concluded that getting screened for breast cancer so early and so often leads to too many false alarms and unneeded biopsies without substantially improving women's odds of survival.

"The benefits are less and the harms are greater when screening starts in the 40s," said Dr. Diana Petitti, vice chair of the panel.

The new guidelines were issued by the U.S. Preventive Services Task Force, whose stance influences coverage of screening tests by Medicare and many insurance companies.

But Susan Pisano, a spokeswoman for America's Health Insurance Plans, an industry group, said insurance coverage isn't likely to change because of the new guidelines. No changes are planned in Medicare coverage either, said Dori Salcido, spokeswoman for the Health and Human Services department.

Experts expect the task force revisions to be hotly debated, and to cause confusion for women and their doctors.

"Our concern is that as a result of that confusion, women may elect not to get screened at all. And that, to me, would be a serious problem," said Dr. Len Lichtenfeld, the cancer society's deputy chief medical officer.

The guidelines are for the general population, not those at high risk of breast cancer because of family history or gene mutations that would justify having mammograms sooner or more often.

The new advice says:

_Most women in their 40s should not routinely get mammograms.

_Women 50 to 74 should get a mammogram every other year until they turn 75, after which the risks and benefits are unknown. (The task force's previous guidelines had no upper limit and called for exams every year or two.)

_The value of breast exams by doctors is unknown. And breast self-exams are of no value.

Medical groups such as the cancer society have been backing off promoting breast self-exams in recent years because of scant evidence of their effectiveness. Decades ago, the practice was so heavily promoted that organizations distributed cards that could be hung in the shower demonstrating the circular motion women should use to feel for lumps in their breasts.

The guidelines and research supporting them were released Monday and are being published in Tuesday's issue of the Annals of Internal Medicine.

The new advice was sharply challenged by the cancer society.

"This is one screening test I recommend unequivocally, and would recommend to any woman 40 and over," the society's chief medical officer, Dr. Otis Brawley, said in a statement.

The task force advice is based on its conclusion that screening 1,300 women in their 50s to save one life is worth it, but that screening 1,900 women in their 40s to save a life is not, Brawley wrote.

That stance "is essentially telling women that mammography at age 40 to 49 saves lives, just not enough of them," he said. The cancer society feels the benefits outweigh the harms for women in both groups.

International guidelines also call for screening to start at age 50; the World Health Organization recommends the test every two years, Britain says every three years.

Breast cancer is the most common cancer and the second leading cause of cancer deaths in American women. More than 192,000 new cases and 40,000 deaths from the disease are expected in the U.S. this year.

Mammograms can find cancer early, and two-thirds of women over 40 report having had the test in the previous two years. But how much they cut the risk of dying of the disease, and at what cost in terms of unneeded biopsies, expense and worry, have been debated.

In most women, tumors are slow-growing, and that likelihood increases with age. So there is little risk by extending the time between mammograms, some researchers say. Even for the minority of women with aggressive, fast-growing tumors, annual screening will make little difference in survival odds.

The new guidelines balance these risks and benefits, scientists say.

The probability of dying of breast cancer after age 40 is 3 percent, they calculate. Getting a mammogram every other year from ages 50 to 69 lowers that risk by about 16 percent.

"It's an average of five lives saved per thousand women screened," said Georgetown University researcher Dr. Jeanne Mandelblatt.

Starting at age 40 would prevent one additional death but also lead to 470 false alarms for every 1,000 women screened. Continuing mammograms through age 79 prevents three additional deaths but raises the number of women treated for breast cancers that would not threaten their lives.

"You save more lives because breast cancer is more common, but you diagnose tumors in women who were destined to die of something else. The overdiagnosis increases in older women," Mandelblatt said.

She led six teams around the world who used federal data on cancer and mammography to develop mathematical models of what would happen if women were screened at different ages and time intervals. Their conclusions helped shape the new guidelines.

Several medical groups say they are sticking to their guidelines that call for routine screening starting at 40.

"Screening isn't perfect. But it's the best thing we have. And it works," said Dr. Carol Lee, a spokeswoman for the American College of Radiology. She suggested that cutting health care costs may have played a role in the decision, but Petitti said the task force does not consider cost or insurance in its review.

The American College of Obstetricians and Gynecologists also has qualms. The organization's Dr. Hal Lawrence said there is still significant benefit to women in their 40s, adding: "We think that women deserve that benefit."

But Dr. Amy Abernethy of the Duke Comprehensive Cancer Center agreed with the task force's changes.

"Overall, I think it really took courage for them to do this," she said. "It does ask us as doctors to change what we do and how we communicate with patients. That's no small undertaking."

Abernethy, who is 41, said she got her first mammogram the day after her 40th birthday, even though she wasn't convinced it was needed. Now she doesn't plan to have another mammogram until she is 50.

Barbara Brenner, executive director of the San Francisco-based Breast Cancer Action, said the group was "thrilled" with the revisions. The advocacy group doesn't support screening before menopause, and will be changing its suggested interval from yearly to every two years, she said.

Mammograms, like all medical interventions, have risks and benefits, she said.

"Women are entitled to know what they are and to make their best decisions," she said. "These guidelines will help that conversation."

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Original Post
At one time wasn't it recommened at 35? I disagree also with the mammogram age being increased. While reading this on Facebook, someone made an interesting point, that this change has come right in the middle of the healthcare reform debates and legislation. hhhmmmm???
Originally posted by Yemaya:
At one time wasn't it recommened at 35? I disagree also with the mammogram age being increased. While reading this on Facebook, someone made an interesting point, that this change has come right in the middle of the healthcare reform debates and legislation. hhhmmmm???

17 What if you don't MAKE IT to 50? If you need to go at 35, then go at 35. Moving the age up, is just a ploy to make us negligent about our heath status.
Originally posted by Yemaya:

At one time wasn't it recommened at 35? I disagree also with the mammogram age being increased. While reading this on Facebook, someone made an interesting point, that this change has come right in the middle of the healthcare reform debates and legislation. hhhmmmm???

Very interesting indeed. I heard some quack doctor on the radio trying to explain this change in recommendation in statistical terms. It sounded like hooey. He even quoted a $50K guestimate as the cost of saving a life for one additional year ohsnap

Those people who are objecting to healthcare reforms on the basis of "healthcare rationing" are gonna have a field day with this.

What about the seeminly increasing number of women whove had breast cancer in their 30's?

Why play with women's health?
This smells all about the hospitals and the insurance lobbyists making sure & securing future billions at the expense of women prior to passing health care reform.

Change/revise and enforce a new system now so that the future generations will have to follow these "recommended" guidelines.

Listen to this health panel expert, who was involved in the decision being interviewed by CNN's Dr. Sanjay Gupta.

Makes me wonder, who makes the rules about other time sensitive medical procedures such as checking for prostate cancer and having a colonscophy beginning at a certain age and not before; allowing medical insurance to pick up the costs.
Black women Develop Breast Cancer At Earlier Ages, Have Higher Mortality Rates Than Other Women, Study Finds

14 May 2009

Although black women are one-third less likely than women of other races to develop cancer, they are 30% more likely than other women to die if they are diagnosed with the disease, according to a study published in the Journal of the American College of Surgeons, the Miami Herald reports. For the study, Leonidas Koniaris, a surgical oncologist at the University of Miami Medical School's Sylvester Comprehensive Cancer Center, and colleagues looked at data from the Florida Agency for Health Care Administration and Florida Cancer Data System that included information on 63,472 patients. Researchers found that among women with breast cancer:
72.1% of blacks were diagnosed before age 65, compared with 50.3% of non-Hispanic whites;

At the time cancer was found it had spread to other parts of the body in 5.9% of blacks, compared with 3.1% of other women;

The likelihood of finding breast cancer in black women at age 33 is the same as in finding it in white women at age 40; and

Participants in the lowest socioeconomic category were treated less frequently with surgery and had a lower five-year survival rate.

Researchers said that poverty and cultural issues might prevent black women from receiving the latest, most-effective treatments. Koniaris said that genetics might in part explain why black women get breast cancer at a younger age. He called for public awareness campaigns to alert black women of their risks and better testing and earlier diagnoses among the group.

'Current screening guidelines are not sufficient in detecting breast cancer in African-American patients because the disease has already developed in so many of these women by age 40,' he said (Tasker, Miami Herald, 5/12).

An abstract of the study is available online.

Reprinted with kind permission from You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at The Kaiser Daily Health Policy Report is published for, a free service of The Henry J. Kaiser Family Foundation.

© 2009 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

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Main News Category: Breast Cancer

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This idea that americans are being "over treated" is fascinating to me. It's become a meme repeated on every medium, and yet, i've never met a person who felt their doctor has ordered too many tests.

I've known people who were never correctly diagnosed by doctors and gave up trying to get a diagnosis.

I've known people who couldn't get a doctor to order the tests they believed they needed.

I have never known an "over treated" patient.

What does it look like? Who gets "over treated"?????
Originally posted by Yemaya:
At one time wasn't it recommened at 35?

I think, yes, if you had an primary family member who had been diagnosed (mom, aunt, sister).

Part of this is number crunching by health insurers, but this argument fails for many, reasons. One is that digital mammograms, which are becoming the standard of care, are extremely cheap - in every country except the U.S. That's the issue, here. Why are procedures so friggin' and unnecessarily expensive in the States? Instead of saying, it's too costly for no real therapeutic benefit (which is bs) so let's raise the age requirement, deal with the exorbitant cost of procedures!

The other issue is something I've raised before on this forum, is this expectation that some Americans have for perfect heathcare outcomes. Digital mammograms will pick up EVERYTHING, even suspicious spots that don't mean anything. So, if some women are saying "well doc, you scared me with saying I have a spot or put me through an unnecessary biopsy, so now I want to sue you", that's a bad response to a very sensitive technique and followup. Medicine, even standard of care, is a science, not a mechanical certainty and people need to work with doctors in accepting that reality.

There is so much overwhelming evidence that breasts change and early detection - whether palpated or imaged - saves lives and I'm stunned that the task force even had the nerve to choose this illness above others to reverse standard of care. Hell, why not prostate cancer screenings, men? 6

IMO, not only should mammograms NOT be pushed back to 50, but every woman should have a baseline mammogram done at age 20, age 30, age 40, and every 2-3 years after that, depending on family history. If insurance won't cover it and she's lucky enough to be able to pay for it, then pay for it.
Ladies, here's another "medical" suggestion from the experts:

Young women Can Wait On Pap Smears.

For the second time in a week, a group of medical experts has recommended that some women can be tested less frequently for cancer.

A new guideline suggesting that less testing for cervical cancer makes more medical sense comes as a separate recommendation that women delay the start of routine mammograms until age 50 has become embroiled in the debate over health care reform.

The American College of Obstetricians and Gynecologists just recommended that young women can hold off until 21 before getting their first Pap smear and get them every two years through the rest of their 20s, instead of annually. Previously, the doctor group had said young women should get a Pap smear three years after first having sex or age 21, whichever came earlier.

The doctors also said that women 30 and older who have three consecutive normal pap smears can lengthen the testing interval to three years. Finally, the docs say it's OK to stop pap smears altogether after age 65 or 70 for women who've had three normal pap smears in a row and no abnormal results in a decade.

How is it that the Pap smear rollback came out just as mammography and fears about of rationing of care under changes to health care caught fire?

"It's just pure coincidence that these guidelines have been released now," Dr. David Soper, the Chairman of ACOG's Gynecology Practice Bulletin Committee, told NPR.

They new guideline has been in the works for years and reflects evolving scientific evidence that shows, for instance, the risks of cervical cancer developing in young women is quite low. Indeed, the vast majority of abnormalities found on Pap tests in very young women clear up on their own.

More broadly, Soper told NPR, "You don't improve cancer detection by doing annual smears in women in the different age groups. Performing the Pap test every other year in women between the ages of 21 and 29, and every three years in women over 30 is just as good as doing the test annually. "There's no danger in this new guidance," he said.
fro As a rule I have always been skeptical about mammograms and pap smears.[How many men do you know who would put their "stuff" near radiation?Eek Why is it mostly women?]

Anyway...I remember in the late eighties....early ninties[sp] there were speculation that these tests were monetary driven...and that exposure yearly would increase risk of developing cancer...especially breast cancer. I recall years ago women who were diagnosed for breast cancer....had their breasts removed to find out later it was a default in the machine or that the cancer was as a result of too much [unmonitored] radiation. My thing is...not saying that cancer does not exist..cuz it definitely does....but! How is it that we live in one of the most highly advanced countries in the world...where accessibility to modern medicine is available...not like 3rd world countries.....and yet we have the highest level of cancer. They say....them scientists that is...folks who live in the northern hemisphere located near the tropic of cancer as the most vulnerable as oppose to those who live in the tropic of capicorn..i.e. the southern hemisphere. I don't know. But! I don't trust massa. He is the only individual that can make "bank" off any damn thing he created. Besides living in poverty and war....I don't remember an abundance of people suffering from this as much as we are. 19 Very interestin. But! I'm just sayin.

i do not think we have the highest levels of cancer in world...many third world countries have higher rates of preventable cancers like cervical cancer because of a lack of adequate screening. It seems we have the highest rates of cancer but it is mainly because we have screening programs in the US. Cancer is a genetic disease with the main root causes being mutations and/or rearrangements in the genetic material as a result of viral infections, spontaneous mutations due to the environment, radiation and genetic inheritance. I know cancer exists because my day job involves diagnosing in all of its various forms.
As for the new recommendations, I think it is best to look at the individual patient...if the family history includes early breast cancer less than the age of 50, then I feel a mammogram is warranted.

Dear Sir,
       Unfortunately, not all viruses have a vaccine against them. In thory, it is possible but in reality, that is a different story.  But yes, it is well established that some viruses causes various types of cancer. For example, the human herpes type 8 causes Kaposi's sarcoma in AIDS patients and the Epstein Barr virus (EBV) causes the endemic form of Burkitt's lymphoma which is common in West Africa and not so much here in the States. The form of Burkitts in the US is only associated with EBV is about 40% of cases.

HIV - Karposi's Sarcoma, EBV- Burkitt's Lymphoma, HPV - Cervical Cancer are just a few examples of virally induced malignancies. Wrt vaccination, it's very difficult to develop vaccines against viruses given their easy ability to escape immune surveillance, lie dormant for decades, etc...

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