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Breast cancer

Women in their 40s should consider mammogram every other year, group says

Liz Szabo
USA TODAY
Roxanne Gross, a mammography technologist, performs a mammogram on a patient at the David Geffen School of Medicine at UCLA, Los Angeles CA.

Women in their 40s who are very concerned about reducing their risk of dying from breast cancer may want to undergo mammograms every other year, even though the tests reduce that risk very slightly and carry substantial risks, a panel of federal health advisers said Monday.

Women ages 50 to 74 should get a mammogram every other year, because the benefits of the screenings tend to be greater for older women, who have a higher risk of breast cancer, according to the panel, the U.S. Preventive Services Task Force.

Although the recommendation is nearly identical to advice the task force issued six years ago, the new report goes to greater length to help women make informed choices, says Michael LeFevre,immediate past chairman of the task force. All too often, he says, doctors routinely order mammograms for women at age 40, without any sort of discussion.

"Doctors don't talk about benefits. They don't talk about harms. They don't try to elicit an individual decision," LeFevre says.

Other medical groups advocate more aggressive breast cancer screening.

The American Cancer Society, American Congress of Obstetricians and Gynecologists and the American College of Radiology recommend annual mammograms beginning at age 40.

In a statement, the American College of Radiology, whose members interpret mammograms, says that following the task force's advice would "result in thousands of additional and unnecessary breast cancer deaths each year." The radiology college criticized the task force because, although it includes many doctors, it doesn't include any specialists in breast cancer.

The task force "ignored the demonstrated views of American women on screening," says Barbara Monsees, chair of the radiology college's breast imaging commission. "These recommendations will only add to confusion that is placing women at risk."

The task force's 2009 recommendation ignited a firestorm, because it overturned the accepted wisdom on early detection and because it appeared to advocate rationing care just as Congress was debating the Affordable Care Act.

Although task force members are not government employees, the group's recommendations influence Medicare and other health plans' coverage decisions. The group doesn't consider cost when evaluating screenings. Insurers have continued to cover mammograms since the task force's 2009 report.

The task force has never wanted to deny women care, LeFevre says.

"Our goal is to empower women with the science to make make their own decisions," LeFevre says. For women in their 40s at average risk of breast cancer, "the benefits of mammography outweigh the harms, but only by a small amount."

Women at higher risk of breast cancer, such as having a mother or sister diagnosed with the disease, may benefit more from getting screened in their 40s, the task force says.

In general, mammograms offers a much greater benefit for older women, LeFevre says.

If doctors screened 10,000 women every other year for a decade, for example, they would prevent four breast cancer deaths among women in their 40s, eight breast cancer deaths among women in their 50s, 21 breast cancer deaths among women in their 60s and 13 breast cancer deaths among women in their 70s, according to the task force report.

More than 230,000 Americans are diagnosed with breast cancer each year and more than 40,000 die, according to the American Cancer Society.

But cancer screening can also harm women, LeFevre says. About one in five women diagnosed with breast cancer is treated unnecessarily for a tumor that never would have threatened her life. Because doctors can't be certain which breast cancers will prove deadly, they typically recommend treating all of them.

"For every breast cancer death we avoid" through screening," LeFevre says, "two or three will be diagnosed unnecessarily."

The task force didn't offer any advice on some of the newer controversies in breast cancer screening. It didn't weigh in on whether so-called 3-D mammograms are better than conventional ones, or whether women need additional tests if they have denser breast tissue, which can produce less clear images. There simply isn't enough information about these issues to know either way, LeFevre says.

Today, some people who were on opposite sides of the mammogram debate six years ago have come closer together.

Otis Brawley, chief medical officer of the American Cancer Society, says he respects the task force's emphasis on science.

"People in the United States think that breast cancer screening is better than it is," Brawley says. "We have done a poor job at explaining the limitations of mammograms."

Brawley says researchers urgently need to come up with more effective breast cancer screenings, noting that too many women still die from the disease, including many who were screened early.

"Even if you have a population where everyone gets screened appropriately, 70% of the women who were destined to die from breast cancer still die," Brawley says. "Rather than rest on our laurels, we need to ask ourselves, 'What are we doing to improve that number?'"

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