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New Mammography Guidelines for Women

Women in Their 40s Should Discuss Risks, Benefits With Doctors, Says Physicians Group
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WebMD Health News
Reviewed by Louise Chang, MD

April 2, 2007 -- The American College of Physicians today issued new mammography guidelines for breast cancer screening for women in their 40s.

The guidelines boil down to this: Women in their 40s should work with their doctors to gauge their personal breast cancer risk and to decide whether to get mammography to screen for breast cancer.

If a woman in her 40s decides not to get a screening mammogram, she and her doctor should revisit that decision every one to two years, states the American College of Physicians (ACP).

In short, the ACP isn't making a one-size-fits-all recommendation. Instead, the ACP says the decision should be tailored to each individual woman in her 40s.

"No simple recommendation applies to all women in their 40s," states an editorial published with the guidelines in the Annals of Internal Medicine.

The guidelines only apply to routine screening mammograms, not diagnostic mammograms taken of specific breast lumps or other breast findings.

Mammogram Studies

A team of experts reviewed 125 mammography studies for the ACP. They included Katrina Armstrong, MD, MSCE, of the University of Pennsylvania.

"Screening mammography probably reduces breast cancer mortality in women aged 40 to 49 years modestly," write Armstrong and colleagues.

They note that many women in their 40s will choose mammography for that potential reduction in breast cancer death.

However, Armstrong's team notes that screening mammograms likely save more lives in women aged 50 and older, since breast cancer becomes more common with age.

In addition, mammograms aren't perfect. They may miss a tumor or flag a benign breast lump, leading to more tests and anxiety.

Mammograms also deliver a low dose of radiation, and it's not clear what the long-term consequences of that may be over a lifetime, note Armstrong and colleagues.

Many women find the mammography procedure uncomfortable. But in the reviewed studies, few women said mammography pain would stop them from getting a mammogram.

Personal Decision

Women's breast cancer risk depends on age, family history, and many other risk factors.

A woman in her 40s should gauge those risk factors with her doctor and decide how she feels about getting mammography to screen for breast cancer, notes the ACP.

"Because of the variation in benefits and harms associated with screening mammography, we recommend tailoring the decision to screen women on the basis of women's concerns about mammography and breast cancer, as well as their risk for breast cancer," write Armstrong and colleagues.

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