That change from annual screening beginning at age 40 is "ill advised and
dangerous," say the American College of Radiology and the Society of Breast
Claiming that the new guidelines will cause "countless unnecessary breast
cancer deaths each year," the groups call for a return to annual screening at
age 40 for average-risk women, and annual screening starting at age 30 (or even
as early as age 25) for higher-risk women.
The USPSTF calculates that the greatest benefit of breast cancer screening
is for women ages 60 to 69. Evidence on women 75 years or older does not exist.
For younger women, the USPSTF calculates that to extend the life of a just one
woman, 1,904 women ages 40 to 49 and 1,339 women ages 50 to 59 must be
That's where the debate begins. A woman's risk of breast cancer starts
rising sharply at age 40. The USPSTF calculates that breast cancer risk gets
large enough by age 50 to justify the "potential harms" of screening.
These harms include anxiety over false-positive results and painful,
unnecessary biopsies. The radiology groups say the risk at age 40 already
justifies any such harm -- and that catching cancer at an earlier stage
prevents the harm of more difficult late-stage treatment.
Because women have been taught for years that breast cancer is most curable
and most easily treated when caught early, the USPSTF guidelines were met with
a public uproar. Health and Human Services Secretary Kathleen Sebelius soon
told women under 50 that the suggested guidelines would not become federal
Now radiologists have officially joined the uproar. Memorial Sloan-Kettering
radiologist Carol H. Lee, MD, chairwoman of the American College of Radiology
Breast Imaging Commission, condemned the USPSTF recommendations as
"The USPSTF recommendations are a step backward and represent a significant
harm to women's health," Lee says in a news release. "At least 40 percent of
the patient years of life saved by mammographic screening are of women ages 40
Lee and colleagues put forth the radiologists' own guidelines in a strongly
worded article in the January issue of the Journal of the American College
of Radiology. Those recommendations include:
Regular annual screening beginning at age 40 for women at average risk of
Regular annual screening beginning at age 30, but not before age 25, for
women with increased risk of breast cancer due to BRCA1 or BRCA2 gene
mutations, a mother or sister with premenopausal breast cancer, or both a
maternal and paternal relative with premenopausal breast cancer.
Regular annual screening should continue for all women with a life
expectancy of less than five to seven years, based on age or health
While the USPSTF has already softened the wording of its original
guidelines, the panel continues to recommend mammograms every other year.
As for women under age 50, the USPSTF now suggests that the decision to
start breast cancer screening "should be an individual one and take patient
context into account, including the patient's values regarding specific
benefits and harms."