New Mammography guidelines issued for younger woman

Contrary to a widely accepted recommendation that women should routinely undergo mammograms in their 40s, a physician's group from the American College of Physicians released a new set of guidelines, recommending that mammography screening decisions should be made on a case-by-case basis.

The new mammography guidelines, which are published in the April 3 issue of the Annals of Internal Medicine, advise women 40 to 49 years old should talk with their doctor before making a decision to undergo the breast examination.

Despite the fact that mammogram screenings can reduce mortality from breast cancer in 50- to 70-year-old women, but, according to new guidelines, the benefits of screening for younger women are not uniform.

"The evidence is not strong enough to say that all women should be screened and it should be based on individual reasons," said Dr. William Golden, who is chair of the board of regents for the American College of Physicians.

According to a report, released by the U.S. Centers for Disease Control and Prevention earlier this year, mammography screening can reduce breast cancer deaths by about 20 to 35 percent in women aged 50 to 69 and by about 20 percent in women aged 40 to 49.

The American College of Physicians, which is the leading professional organization for internal medicine specialists, with a membership of 120,000, based its recommendations on a rigorous review of evidence showing there is variation in the benefits and harms associated with mammography among women in their 40s.

The guidelines, meant to be used by practicing physicians, urges clinicians to discuss the benefits and harms of screening with the patient, as well as each woman's individual cancer risk and preference about screening.

"There are important benefits to screening mammography, but we believe the decision to be screened should be based on an informed conversation between a patient and her physician," said health policy expert Douglas K. Owens, MD, MS, a researcher with the Veterans Affairs Palo Alto Health Care System who also chaired the committee that developed the guidelines. "In our view, the evidence doesn't support a blanket recommendation for women in this age group," added K. Owens, who is also a professor of medicine at the Stanford University School of Medicine.

In 2006, guidelines issued by the American Cancer Society recommended annual mammograms for women beginning at age 40. And, the U.S. Preventive Services Task Force and the American College of Obstetricians and Gynecologists both recommend screening mammography every one to two years for women 40 and older.

But, the latest guidelines do not agree with earlier recommendations issued by different medical groups. Instead of making mammography mandatory, the new guidelines recommend that the screening should be based on an informed conversation between a patient and her doctor.

The novel study found that the risk of breast cancer among younger women varies greatly. While a 40-year-old woman with no risk factors has about a 1 percent chance of getting breast cancer, a 49-year-old woman with multiple risk factors, like family history and early onset of menstruation, has about a 6 percent risk.

Breast cancer is the second-leading cause of cancer related death among women in the United States, after lung cancer. According to the American Cancer Society, 25 percent of all woman diagnosed with the disease are younger than age 50. In 2007, an estimated 178,000 American women will be diagnosed invasive breast cancer, which would engulf around 40,000 lives.