American Cancer Society Urges Women to Start Getting Mammograms at 45

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Six years ago, the American Cancer Society lashed out against a federal task force that suggested most women could wait to get a mammogram until age 50, instead of age 40, the age that other groups recommended to begin breast cancer screening. Delaying mammograms, the cancer society said, would lead to the death of more women.

Now, in a move that reflects changing attitudes about cancer screening, the American Cancer Society is itself recommending fewer mammograms.

In guidelines released Tuesday, the society said that women at average risk of breast cancer should begin annual mammograms at age 45 – five years later than it had previously recommended. The society said it reached this conclusion after carefully weighing both the benefits and harms of mammograms for younger women, whose risk of breast cancer is much lower than that of older women.

By age 55, women can transition to being screened every other year. That’s because breast cancers tend to grow more slowly after menopause, making it safe for women to be checked less often, according to the guidelines, published online Tuesday in JAMA, formerly the Journal of the American Medical Association.

In another major change, the society said doctors no longer need to perform breast exams during women’s checkups, since these exams have not been shown to save lives.

These are big changes for the American Cancer Society — the USA’s largest cancer charity and perhaps the best-known advocate for screening. As recently as 1992, the American Cancer Society recommended women get a “baseline” mammogram at age 35 to 39, so that doctors would have an image for comparison to their later screening results.

The new guidelines reflect the growing recognition that mammograms can do harm, as well as good, said Richard Wender, chief cancer control officer at the American Cancer Society.

“The biggest evolution has been not in the American Cancer Society, but in the science of cancer screening and the evolution of health care in general,” Wender said.

The society now promotes a mammogram schedule adapted to the biology of breast cancer and a woman’s changing risk as she ages, Wender said. The society picked age 45 as the start date for screening because that’s when a woman’s risk of breast cancer begins to spike. Before that, a woman is more likely to be hurt than helped by mammograms, which can produce “false positive” results that may lead women to undergo unnecessary follow-up tests, including invasive biopsies.

A less common, but far more serious, problem caused by mammograms is “overdiagnosis,” which occurs when screening tests detect slow-growing cancers that may never to threaten a woman’s life. Because doctors can’t tell which breast tumors are essentially harmless, they end up treating all of them. That can lead women to undergo surgery, radiation or other treatments they don’t need. Although studies have estimated that up to half of breast cancers don’t need to be treated, the cancer society now says that the true number is between 1% to 10%. The cancer society estimates that nearly 232,000 women will be diagnosed with breast cancer in 2015 and more than 40,000 will die from it.

The cancer society’s last update on mammograms, published in 2003, barely mentioned overdiagnosis, finding “little to no evidence” for it.

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Source: USA Today | Liz Szabo