The guidelines for when, how many and at what age a woman should get a mammogram can be confusing, especially for those with an increased risk of breast cancer.
The United States Preventive Services Task Force, a panel of medical experts, released new mammogram guidelines in January that recommended fewer screenings than in the past.
“The United States Preventive Services Task Force evaluated the evidence that has emerged since its last update (2009) and has reconfirmed its conclusion that mammography reduces breast cancer deaths for women 40 and older. The panel recommends that all women ages 50 to 74 be screened every two years, giving this recommendation a ‘B’ rating. The panel concluded that the benefits of screening women in their 40s are greater than the harms but that the difference is small. For this reason, the panel gave screening women in their 40s a ‘C’ rating,” said Dr. Richard Wender, chief cancer control officer at the American Cancer Society.
These guidelines created a sense that the task force “didn’t consider screening starting at age 40,” Wender said.
But, “The American Cancer Society recommends that all women definitely start by 45 if they haven’t started earlier. The United States Preventive Services Task Force says 50 is the definite start date for all. American Cancer Society recommends annual screening until after 55, at which point a woman can transition to every other year,” Wender said.
For ‘average’ women
“This guideline is not for women who have the BRCA mutation or a very strong family history or a personal previous history of cancer. It’s for women at average risk. The average risk category is a broad category. Some women have no family history; others may have had one relative with breast cancer. African-American women are at slightly higher risk of developing breast cancer at a young age, and this may influence a decision to start screening at age 40,” Wender said.
Why the differences?
Different groups recommend different but similar guidelines as they balance the benefits and harms of screening to make a recommendation.
“Guideline groups put somewhat different weight on different types of evidence. Guideline groups have different perspectives, so it’s not surprising that different groups have somewhat different guidelines, but the differences in the guidelines have been overemphasized. There are more similarities than differences,” Wender said.
• All women should consider beginning screening at age 40.
• All women should begin screening by 50 at the very latest but most will want to start screening before then. American Cancer Society recommends 45 at the latest.
• All women should have regular screening every one to two years from age 50 as long as they remain healthy with at least a 10-year expectancy.
Covered by insurance?
“This is complicated. Congress passed a ruling that mandates coverage of annual mammography for women 40 and older. So the simple version is — yes. It’s covered,” Wender said. “Far too few women are being regularly screened. Screening saves lives and everyone should be up to date with regular screening.”