Researchers Question Mammogram Guidelines

May 2, 2011 -- The recent guidelines issued by a government task force that do not recommend routine annual mammograms in women 40-49 may be having a negative impact, according to new research.

If screening mammograms are not done routinely in women in this age group, says researcher Lara Hardesty, MD, chief of breast imaging at the University of Colorado Hospital, Denver, "I am concerned the only way the breast cancer in these women will be detected will be when they are large enough to be felt by either the women or their health care provider."

Hardesty presented her research at the American Roentgen Ray Society annual meeting in Chicago.

She found a drop in the number of women ages 40 to 49 getting mammograms routinely at her hospital after the November 2009 guideline on mammography was issued by the U.S. Preventive Services Task Force (USPSTF). The mammography guidelines suggest women 40-49 discuss the risks and benefits of having a mammogram with their doctor and decide what to do on an individual basis.

The American Cancer Society and the American College of Radiology advise women to begin routine screening annually at age 40.

In another study presented at the same meeting, Donna Plecha, MD, director of breast imaging at University Hospitals at Case Medical Center in Cleveland, reported that cancers found in women 40 to 49  who had screening mammograms were smaller and found earlier than those found in women who did not  have the test.

However, the current chair of the task force says the data from the study doesn't change what is known about the value of the test in women 40 to 49. "The recommendation of the task force is that the decision to screen should be individualized for women in this age group, taking into account each woman's values and her specific situation," says Virginia Moyer, MD, who is also professor of pediatrics at Baylor college of Medicine and Texas Children's Hospital in Houston. She reviewed the studies for WebMD.

Survey of Health Care Providers

Hardesty surveyed 303 health care providers at her hospital. She asked about their practices in recommending mammograms, by age group. In all, 16.5% of the health care providers responded.

Before the USPSTF guidelines took effect:

• 56% recommended annual screening for women 40 to 49.
• 33% recommended screening every two years.
• 11% recommended no screening.

After the USPSTF guidelines were issued:

• 20% recommended annual screening for women 40 to 49.
• 18% recommended screening every other year.
• 8% recommended not screening.
• 54% discussed the risk and benefits on a one-to-one basis, which is recommended by the USPSTF guidelines.

Hardesty also compared the number of screening mammograms done at her hospital in women 40 to 49 and in those age 50 and above in two time periods. The first was nine months before the USPSTF guidelines and the second was nine months after.