June 26, 2017

Most 40-year-old women should talk to their doctor before getting mammograms, ACOG recommends

Daily Briefing

    The American College of Obstetricians and Gynecologists (ACOG) on Thursday released new recommendations for mammograms— advising women at average risk for breast cancer to consult with their health care providers about whether they should start regular mammograms at age 40.

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    According to Reuters, the updated recommendation, which was published in the July issue of Obstetrics & Gynecology, falls more in line with guidelines from other organizations—such as the U.S. Preventive Services Task Force (USPSTF) and the American Cancer Society (ACS)—but still adds new flexibility to the complex and evolving landscape of recommendations on mammograms.

    ACOG in previous recommendations advised women to start annual mammograms at age 40.

    Recommendation details

    ACOG in the guideline recommends health care providers offer annual or biennial mammograms to women at average risk of breast cancer starting at age 40. But before beginning routine mammograms, women in their 40s at average risk for breast cancer should discuss the risks and benefits of mammograms with their health care providers, according to the new recommendations.

    ACOG officials in a statement said starting mammograms at age 40 is tied to lower breast cancer mortality among average-risk women, but mammograms also can expose women to harms, such as anxiety, callbacks, false-positive results, over-diagnosis of breast cancer—which ACS said ranges widely from 0 to 54 percent among breast cancers—and overtreatment.

    ACOG said women's discussions with their health care providers should center on mammograms within the context of the woman's health history, covering not only the benefits and risks of screenings, but discussing the patient's concerns, priorities, and preferences, according to ACOG.

    According to the new recommendations, women should start regular mammograms no later than age 50, and should continue either annually or biennially—as determined by each woman and her provider—until at least age 75. Women should consult with their health care providers to decide whether to discontinue mammograms after age 75 based on their health status and predicted longevity.

    ACOG in the recommendations advised against regular self-examinations, but said women should be aware of the normal appearance and feel of their breasts to report changes to their health care providers.

    Discussion

    Christopher Zahn, a physician and the vice president of practice activities at ACOG, said the new recommendations attempt to strike a balance between the benefits and harms of mammograms. He said ACOG's latest recommendations reflect a new interpretation of the available data, and "conside[r] each individual patient and her values." He added that ACOG "moved toward encouraging obstetrician-gynecologists to help their patients make personal screening choices from a range of reasonable options," because of the range of recommendations currently available, including guidelines from USPSTF and ACS.

    ACS Chief Medical Officer Otis Brawley said the evidence is clear that mammograms save the lives of women over 50, but for younger women, these tests could set off false alarms and lead to unnecessary biopsies. Brawley said the new recommendations reflect " more of a respect for the individual person" (Seaman, Reuters, 6/22; Bankhead, MedPage Today, 6/22; Hobson, "Shots," NPR, 6/22).

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