Boston Doctors Have Mixed Feelings About New Mammogram Guidelines

Mammography photo by NASA Goddard Space Flight via Flickr/Creative Commons

UPDATED, January 13, 1 p.m.:

The U.S. Preventive Services Task Force released its final recommendations for breast cancer screening, which differ from the American Cancer Society policy. The new guidelines leave the age at which mammograms should start largely up to individual women, saying that those who opt to could get one every two years starting at age 40. It also recommends that women between the ages of 50 and 74 have a screening every two years; after that, it says they are not beneficial enough to be justified.

Original story:

On Tuesday, the American Cancer Society (ACS) issued a controversial new guideline for mammograms: that women of average breast cancer risk should have their first test at age 45, as opposed to its prior recommendation of age 40.

After the initial test, the ACS recommends, every woman should have yearly mammograms until age 54, at which point she should switch to every other year as long her health is stable. In addition, the new guidelines say that doctors no longer need to perform manual checks for breast lumps.

Perhaps unsurprisingly, the statement has already garnered significant media attention, with supporters lauding the guideline as a way to cut down on false positives and inaccurate tests and protesters saying relaxing recommendations will negatively affect women’s health. The call has also gotten a mixed response from doctors—many of whom feel that the old standard of check-ups starting at age 40 is a safer choice.

Rebecca Yang, director of Lahey Hospital & Medical Center’s Breast Health Center, says the staff at Lahey stands behind the old mammogram guidelines—a decision they had reaffirmed in a meeting just before the ACS announcement broke. “Eighty percent of women who are diagnosed with breast cancer are considered at average risk for breast cancer—they don’t have any significant family history,” she says. “You could be missing a number of women who could detect an early breast cancer that is curable.”

Yang also noted that the data the ACS used to make its new recommendation was not based on the most up-to-date mammography technology available.

Like Yang, Alan Semine, chief of breast imaging at Newton-Wellesley Hospital, takes issue with the shift. “The ACS recommendations have gone from clear, simple, and optimal to patronizing and confusing,” he says. “Women in their early 40s can decide for themselves whether they can tolerate the “harm” of needing additional mammograms to resolve questions.”

Further, Semine says, the call for a mammogram every two years after age 54 has the potential for serious consequences. “It’s hard enough to keep track of annual mammograms—life gets in the way,” he says. “To aim for every other year will surely result in intervals of three and four years.”

The ACS is not without its supporters, though. Nancy Keating and Lydia Pace, both of whom work in the Division of Internal Medicine & Primary Care at Brigham and Women’s Hospital, issued a joint statement in favor of the move.

“Although mammography is currently the best screening test we have, its benefits are modest and its harms are real,” they wrote.  “The chief harm is over-diagnosis, which occurs when screening tests detect cancers that would never progress to become clinically evident in the absence of screening, and leads to unnecessary treatment.”