New Advice: Skip Mammograms in Your 40s

Gov't Panel Says Wait Until Age 50 Because Getting Screened for Breast Cancer Too Early is Harmful; Cancer Society Disagrees

(CBS/AP)  Last updated 6:30 p.m. Eastern

Most women should wait until age 50 to get mammograms and then have one every two years, a government task force said Monday in a major reversal that conflicts with the American Cancer Society's long-standing recommendation of annual screening starting at 40.

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

For nearly two decades, the cancer society has been recommending regular mammograms beginning at 40.

But the government panel of doctors and scientists concluded that getting screened for breast cancer so early and so often is harmful, causing too many false alarms and unneeded biopsies without substantially improving women's odds of surviving the disease.

"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 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 American Cancer Society rejects the new guidelines - arguing any lives saved by mammography are worth the expense, reports CBS News medical correspondent Dr. Jennifer Ashton. It will continue to recommend annual screening for all women beginning at 40.

"We have made significant gains in reducing deaths from breast cancer over the past 19 or 20 years, and those gains in no small part are based on women starting at 40 and getting screened every year," said Dr. Leonard Lichtenfeld of the cancer society.

Forty-two-year-old Jessica Moser was afraid she might die when she was diagnosed last year with cancer in both breasts, Ashton reports. But her surgeon said she had a better chance because her cancer was detected early - through a routine mammogram.

She believes younger women should have mammograms.

"To have the technology and to not take advantage of it - would be a real loss," Moser told Ashton. "It would be throwing away something that could help you."

However, 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."

[DeaconPeach]

I found my first lump through self-exam at 29 - luckily it was non-cancerous. I found my second lump through self-exam at 32 - there were cancerous cells in this one & I ended up having a single mastectomy 4 months later. Each time the lump was a rare, fast-growing type (first one was the size of a softball, second one I found sooner & thus was only the size of a baseball). I am 44 now & meticulously have my annual mammogram. If these guidelines had been in place then, I would be typing this post from inside my casket, 6 feet underground.

Thank you government task force for wishing death on all young women under the age of 40. May each of you task force members die an equally painful death.

[cyndy397]

What proves to me this is a purely fabricated report is the statement that self-exams are a waste of time. My mother, sister-in-law, and best friend all had breast cancer--and they all three were the first to find their lumps. So why should I believe anything this bogus task force has to say? Other than to promote Obama's "rationed medical care."

[Sloughfoot]

Wonder if the female members of this panel, (in their 40s) will not have mammograms. By "Panel of experts" it is decided that who can live and who can die from breast cancer - same/same panel to be appointed by the Prez for the proposed health care bill - Doctoring by panel of experts - just love it don't you. Before some you jump my bones just read the first few pages of the bill.

[The_One_King]

So the government wants women to stop having test. Test that could save their life. Just wait and see what happens if Obama takes total control of health care. People had better wake up and fight this government control health care takeover.

[hungry1968-17]

Why are you claiming that there is going to be "total control of health care"?

Even Rush hasn't fabricated BS that big!!

[th9876]

What is everyone so afraid of? Just keep getting the check ups. Insurance companies can't stop you from doing that. They may stop paying for them though - and if they want to stop, they will regardless. Insurance companies are absolute evil. Don't worry, keep checking!

[on_alert247]

"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. " Does anyone see the connection here between the new govt. guidelines and the impending legislation providing govt. healthcare?

[mitdgreenb]

AOCGUY -- could not have said it better myself.

[claw7]

I am outraged by the new recommendation. I found my breast cancer at the age of 35 by self exam. I do not have a family history of breast cancer. This can happen to anyone and the tools to detect should be available to all ages. Instead of raising the age recommendations, they should be lowered to age 30. I am alive today because of self awareness of breast exams!

[garnetann]

this goes out to all women thinking of putting off a mammogram until age 50.
Sorry guys before you all cancel your mammos, I was 46, no family history, no risk factors. The tumor was found by me SBE and confirmed by a mammo. It was less than 2 cm and had not spread to my lymph nodes. But it was in the lymph channels meaning it was traveling to my nodes. Once there, it spreads through your whole body. Remembering I was found clean one year before, so that tumor grew that much in one year. If I had waited until I was 50 to be tested, I would be facing a death sentence. I am not willing to take that chance, are you?
Oh, unless the thought of having your breasts hacked apart, getting poisoned with chemotherapy (that was fun, let me tell you) and getting hit with radiation is an appealing thought...

[tarheelterri]

As a nurse practitioner working in Ob/Gyn for 17 years with a large group of MDs, NPs, & CNMs, we have seen more women than you would imagine with breast cancer in their 30s, 40s, 50s and so on. Some diagnosed by mammogram and nonpalpable, other's found by the patient and some by the clinician. I will always remember the 23 yr old young woman who found her breast cancer by personal check. One would think at this age, the cancer would have been genetic and aggressive. However, it was not. The cancer was treated with lumpectomy and radiation and the outcome was a blessing -- thanks to self breast examination. As a nurse practitioner, I am seeing more breast cancer and at younger ages. All women, please continue to check your breasts, have your yearly mammograms and remember to share your family history with your clinician.

[lanesky]

The question is? Would this Panel tell their own daughters.......Oh!Don't worry about early detection for Breast Cancer mammograms, self exams,thats not even a worry until your 50 YEARS OLD!! I was diagnosed at the age of 34 with breast cancer! With no family history I had mastectomy and 5 yrs later am a BREAST CANCER SURVIVOR!!! Thanks to a great invention the MAMMOGRAM MACHINE and listening to other womans stories of being diagnosed at a early age! I am still living! With my loving husband and 2 young Boys!! Now I am now starting a new journey with one of my best girlfriends that fought her insurance to pay for a mammogram because she is 37 and has realized that early detection is key!! Her mammogram results came back 2 weeks ago!! Guess what Panel! Cancer! Yes another young woman diagnosed at age 37! Detected by a MAMMOGRAM!! She will be having a double mastectomy and chemo!! So go head wait till your 50 to catch that evil thing called CANCER!!!!!!

Most women of reason have stopped taking these deadly mammograms. Hello----the side effect of radiation is cancer. Posted by Baileyccc

[tarheelterri]

You need not to worry about getting cancer from the amount of radiation you receive by a yearly mammogram. Most women have not stopped mammography. My mother's breast cancer was detected by mammogram and was nonpapable. Please take care in your postings.....

[bubbadubba]

As a researcher (but not a doctor), I know the research results in the studies below are absolutely true. Mammograms also have a high false positive rate. The most sensitive area of women to radiation related cell mutation is the breast. The breast is also a location of the highest concentration of Ocogenes which are cells that mutate into cancer. Studies have been done in Sweeden and other European countries that prove yearly mammograms increase breast cancer which is why breast cancer is on the increase in the US and not simply that people are getting early detection which finds the cancer they would not have found. My wife gets a mammogram every 5 years because she knows the work I do. As an alternative if your insurance will pay for it, women may want to get a 3D digital ultrasound which is harmless and much more accurate however the machines are expensive and many medical imaging facilities would rather continue using old paid off machines for more profits (that's what radiologists told me). I am just posting this because I notice a lot of people are posting "facts" that are not correct. My wife's mother is 84 years old and has NEVER had a mammogram. They did a mammogram as part of a physical and found a lump, removed it as cancer ( in a hurry to save her life they said) and it turned out it was a false reading and was a cyst. Do what you think is best but at least have an open mind. Radiation charts show that a mammogram is at .7 mSv (millisievert) while a chest X-ray is at .1 mSv meaning the mammogram is 600% higher dose of radiation but that reading only applies if the facility has the latest machine (most don't) and if not the dosage is much higher, as high as 1000% more radiation than a chest X-ray. As a measuring point, an X-ray of an arm or leg is .001 mSv.
The point of my post is that the government is right and that the insurance and hospital industry are objecting because it will cost them large profits from mammograms. Believe who you want to, it's your life.

"According to Russell L. Blaylock, MD, one estimate is that annual radiological breast exams increase the risk of breast cancer by two percent a year. So over 10 years the risk will have increased 20 percent. In the 1960s and 70s, women, even those who received 10 screenings a year, were never told the risk they faced from exposure. In the midst of the 1976 radiation debate, Kodak, a major manufacturer of mammography film, took out full-page ads in scientific journals entitled About breast cancer and X-rays: A hopeful message from industry on a sober topic.

Despite better technology and decreased doses of radiation, scientists still claim mammography is a substantial risk. Dr. John W. Gofman, an authority on the health effects of ionizing radiation, estimates that 75 percent of breast cancer could be prevented by avoiding or minimizing exposure to the ionizing radiation. This includes mammography, x-rays and other medical and dental sources."

[plantlady2]

A lot of what you say is true, however, what will you say when it is your wife or daughter who is diagnosed with stage 3 cancer undetected because you who are 1) not a doctor 2) is a researcher for whom??? an insurance company perhaps or part of the research that this article is based on 3) quoting info from a 30 year advertisement that used the technology of 1976 which was highly advanced for that period of time but obviously not as sophisticated as what we have 30 years later--hindsight is wonderful.

[mcapek]

Few corrections...3D digital ultrasound is extremely time consuming. Ultrasound can and does miss small cancers, and it cannot detect cancers that manifest only by microcalcifications. So if you don't mind missing those cancers, stick to ultrasound. By living in Chicago you get 1.0 mSv per year from background radiation and cosmic rays, by living in Denver (high altitude) you get 2.0 mSv per year from background radiation and cosmic rays. Your point about chest xray applies only to PA film, which goes through gas filled lungs that absorb little radiation. Lateral chest film dosage is substantially higher, because of all the soft tissues from side to side. What large profit from mammograms? $50 to 100 profit (plumber or electrician does better than that) for a risk of 3 to 7 million dollar lawsuit from misdiagnosis? What is the most frequent category of medical malpractice lawsuit? Missed breast cancer diagnosis! Old paid off machines? Are you kidding? Radiology equipment is being upgraded every 5 years or so, today for digital mammography, in few years for digital tomosynthesis mammography, progress marches on. All estimates of increased radiation risk are based on atomic bomb effects, but those were massive radiation doses, and nobody, no scientist, knows whether the relationship between low dose radiation and increased cancer risk is linear or a curvilinear (much less risk). Nobody knows, Dr. Gofman does not know, no such studies have been done, since obviously nobody volunteers for them.

[bossmare]

Call me skeptical but I think this article is the work of insurance companies trying to scare the daylights out of women and they're succeeding. Ninedogs is on the right track. I don't trust the insurance companies because they're fighting for their lives and they'll do and say anything to save their hides. Remember.......it's all about MONEY!

[99mountain99]

I am a 41 year old , who has already had issues in this field, by self exam they were found and that was when I was 31 and then the next one was when I was 35. So for the government and ins. to say all of this is crazy. women and men both are getting cancer at younger ages evey year. Thanks to the pro active doctors and the many of cancer programs and fund raisers we are able to catch cancer early. My Grandmother always said never move backwards always move slow and forward. Girls always check , you are your best doctor!!!

[erasmus111]

by hahudson November 16, 2009 7:00 PM EST
The radiation dose in mammography is very minimal.

Yes, that's what they all say. But after years of getting mammograms, chest x-rays, dentist x-rays etc., along with the microwave, smoke detectors, t.v.,....the list goes on and on. The funny thing is that they are probably one of the reason why we are getting so many cancers now.

"Mammograms save lives; I've seen it first hand in my patients."

I am not saying to never get them. I am saying that you should try to limit them unless you have a history of breast cancer.

I know several people that have had breast cancer. They died. They did the self breast exams, they had the mammograms regularily and none of them picked up on the cancer they had.

And I wonder how many cases of skin cancer are the results of all the dental x-rays over the years. There are some dentist that take x-rays every six months.

[carolblaschka]

I was first diagnosed with breast cancer at age 40. I found it doing a self-breast exam. They mentioned tonight that self-breast exams don't save lives, but I disagree. Nothing showed up on my mammogram, but luckily I insisted it be checked out even after the general surgeon said it was a 99% chance of being nothing. I have no family history of breast cancer, but since then have had it 3 more times even with chemo, radiation and 5 years of Tamoxifen. Now after a lumpectomy and two mastectomies, I still insist on an MRI each year, because with 1-2% of breast tissue still present, I could still get breast cancer again. I think women should be allowed to have mammograms starting at age 40, younger if they have a family history or at high risk, and they still need to educate about self-breast exams. I know many women who have been saved with mammograms and along with self-breast exams, lives will be saved.

[erasmus111]

by hahudson November 16, 2009 7:00 PM EST
Please don't talk of things, you don't know anything about.


Hmmmm, let's see, should I believe YOU or should I believe the people that I know that work with it?

[duck55--]

My daughters insurance co. told her they would not pay for a mamogram until she was 40 years of age, although there was breast cancer in the family. At the age of 40 she had her first mamogram. It reveiled she had breast cancer. Both breasts + lymp nodes had to be removed. Her specialist to her if she had had a mamogram at 35 she would not have had to go through with this pain and suffering. Three years later she is still suffering this dreadful ordeal.
I question why we pay for insurance from birth on only to not be able to use it when potential problems might exist. Shame of the gov. Insurance and the like to tell an insurance holder they have to wait to get a mammogram or anything else that might make a healthier existance.

[plantlady2]

As a survivor who was diagnosed at age 48 and who has 3 other friends who were diagnosed before the age of 50 and are survivors, I find these "new guidelines" to be totally irresponsible on the part the government and this "task force". Wake up America, this is what you are in for with "national health insurance". Even if the mammograms save 5 lives out of 1000 as quoted, those are 5 women who are someone's mother or loved one. We are human beings, not statistics. Has the government and insurance companies not figured out yet that it is cheaper to do preventive care for thousands of women than do drastic, expensive care to 1 person who has passed from a stage 1 cancer to stage 3 or 4 because they waited too long to get tested?

[mom2222]

I have been having a mammogram since I waS 35 YEARS OLD. i AM NOW 52. mY GRANDMOTHER HAD BREAST CANCER, MY MOTHER HAD BREAST seven years ago. I will continues to have this test as long as I live. My sister and I may get baest cancer or my not but the test is one thing I will do and sleep at night. No big brother for me ,I love the insurance I have .No thanks to the goverment.