Breast Cancer Health Center

Researchers Question Mammogram Guidelines

Survey of Health Care Providers continued...

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.

Moyer warns that the public frequently misunderstands the task force guidelines and thinks no women 40 to 49 should get a mammogram. Actually, she says, the guidelines recommend a woman discuss it with her doctor and decide.

"'We do know that on average, screening results in some degree of benefit for women from 40 to 74 years of age," she says. "For women in the 40- to 49-year-old age group, this benefit appears to be quite small, and has to be balanced against the known risks, which are greater in younger than in older women."

Among the risks are false-positive results and anxiety.

These findings were presented at a medical conference. They should be considered preliminary as they have not yet undergone the peer review process, in which outside experts scrutinize the data prior to publication in a medical journal.