New studies clarify mammogram guidelines

Helen Darling of the San Antonio Silver Stars

Helen Darling of the San Antonio Silver Stars receives a screening mammogram at Christus Santa Rosa Hospital-Westover Hills at the AT&T Center in San Antonio, Texas. (Aug. 18, 2009) (Credit: Getty Images)

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Two new studies have tried to make it easier to determine whether women in their 40s should get routine mammograms, an issue that remains fraught with controversy.

In 2009, the U.S. Preventive Services Task Force, an independent government-appointed panel, created a furor when it determined that the benefits of routine mammogram screening for most women 40-49 were outweighed by the risks of false positive tests and unneeded biopsies. The task force said the decision to get a mammogram for women in this age group was "an individual one." Women 50-75 should be screened every two years, the task force said.

By contrast, the American Cancer Society and American College of Obstetricians and Gynecologists recommend mammogram screening every year beginning at age 40.


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Two studies published this week by the same researchers whose work formed the basis for the task force recommendations found that women 40-49 with a mother or sister who had breast cancer or who had very dense breasts were twice as likely to get the disease. Thus for these women, the benefits of a biannual mammogram outweigh the possible harm, the researchers said, and they are good candidates for screening.

One of the papers synthesized data from 66 other studies. The other used four computer models that simulate life histories for individual women. Both were published in the Annals of Internal Medicine.

Dr. Heidi Nelson of Oregon Health & Science University in Portland, lead researcher in the analysis of the 66 studies, said the hope was to be able to "determine who would benefit from a more aggressive approach, while people who are at lower, average risk can follow less aggressive guidelines."

Dr. Myra Barginear, a breast oncologist at the Monter Cancer Center in the North Shore-Long Island Jewish Health System, praised the study as "helpful" and "good, sound research." But she said she would continue to recommend women 40 and older get mammograms every year.

"In my opinion it doesn't change [most] current guidelines and recommendations," she said. She also said that very dense breasts and having a mother or sister with the disease are known risk factors. "These are not new findings," she said. "It is what you would expect to see."

In an accompanying editorial, Otis Brawley, chief medical officer of the American Cancer Society, said that studies have attributed 15 to 40 percent of the decrease in breast cancer deaths to mammograms. But, he said, "I worry that the public perceives mammography as a better technology than it actually is. . . . Truth be told, it cannot avert all or even most breast cancer deaths."

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