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    Researchers Question Mammogram Guidelines

    Study Suggests Negative Impact From Guidelines That Dropped Routine Mammograms for Women in 40s

    Survey of Health Care Providers continued...

    Before the USPSTF guidelines took effect:

    • 56% recommended annual screening for women 40 to 49.
    • 33% recommended screening every two years.
    • 11% recommended no screening.

    After the USPSTF guidelines were issued:

    • 20% recommended annual screening for women 40 to 49.
    • 18% recommended screening every other year.
    • 8% recommended not screening.
    • 54% discussed the risk and benefits on a one-to-one basis, which is recommended by the USPSTF guidelines.

    Hardesty also compared the number of screening mammograms done at her hospital in women 40 to 49 and in those age 50 and above in two time periods. The first was nine months before the USPSTF guidelines and the second was nine months after.

    She found that before the USPSTF guidelines:

    • 1327 patients 40 to 49 were screened.
    • 4479 patients 50 and older were screened.

    After the USPSTF guidelines:

    • 1122 patients 40 to 49 were screened.
    • 4498 patents 50 and above were screened.

    In her study, Plecha looked at 524 biopsies performed at her hospital. Of those, 108 were found to have cancer.

    "Of those 108,” she tells WebMD, “71 of those were in those women who were undergoing mammography and 37 were in those who were not having mammography screening.” Those detected by mammography were more likely to be found earlier. The tumors were also more likely to be smaller.

    "I would agree with the American Cancer Society and the American College of Radiology to keep the guidelines for annual screening [beginning] at age 40," Plecha says. She reports serving as a consultant last year for Hologic, a medical imaging manufacturer.

    Screening Benefits and Risks

    An expert not involved in the new research cautions that the studies are small. They also involve only local populations. "Thus, they do not provide evidence that is generalizable to the U.S. population," says Robert A. Smith, PhD, director of cancer screening for the American Cancer Society.

    However, he says, it is reasonable to expect a change in referral patterns for screening mammography based on the task force recommendation.

    He is not aware of any national surveys of mammography use since the task force guidelines were issued. So it is not yet possible to measure the nationwide effect.

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