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Mammogram Guidelines

Information About USPSTF's New Mammogram Recommendations

How Do New Recommendations for Breast Cancer Screening Affect You?

Good Friends Talking New recommendations have been released by the U.S. Preventive Services Task Force, a government-appointed, independent panel of medical professionals whose recommendations inform decisions by health professionals and insurers. We hope to provide information so that you can make informed decisions about your own health care. Click here to read The Breast Cancer Site's statement.

The U.S. Preventive Services Task Force has released a recommendation that all American women without a family history of breast cancer receive a mammogram every two years between the ages of 50 and 74. The report does not recommend routine screening mammography in women aged 40 to 49 years. Read more here.

Mayo Clinic and the American Cancer Society continue to recommend screenings for women 40 years of age and older. "Mayo Clinic will continue to evaluate new data on mammography and breast cancer detection as information is made available. But at this time...Mayo Clinic physicians feel it is in the best interests of their patients to offer routine screening mammography." Click here to read the the full text of Mayo Clinic's press release (reproduced with permission).


The Breast Cancer Site's Statement:

Pink Ribbon The Breast Cancer Site, along with the National Cancer Institute, The American Cancer Society, the American College of Obstetricians and Gynecologists, the American Medical Association, and the U.S. Preventive Services Task Force, encourages all women to discuss the risks and benefits of getting a mammogram with their doctors. No one should make this decision for a woman; it should always be her choice when to start screening for breast cancer. Unfortunately, economic barriers too often prevent women who need mammograms from getting them. That is why The Breast Cancer Site free mammograms for low-income, uninsured, and working-poor women.

The most recent and comprehensive research on breast cancer detection clearly indicates that regular mammogram screening saves lives, reducing the rate of death from breast cancer by an average of fifteen percent*. The American Cancer Society and Mayo Clinic recommend that all American women begin scheduling routine mammograms starting at age forty. The U.S. Preventative Services Task Force recommends women without a family history of the disease get a mammogram every two years from ages fifty to seventy-four. Although mammograms are most effective for women over fifty and those with a family history of the disease, they can also detect cancers in younger women without family history. Mammography remains the best tool to detect breast cancer before it spreads.

*U.S. Preventive Services Task Force, November 2009

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Summary of the USPSTF's recommendations and rationale, and a link to the full report.

Importance
Breast cancer is the second-leading cause of cancer death among women in the United States. Widespread use of screening, along with treatment advances in recent years, have been credited with significant reductions in breast cancer mortality.

Detection
Mammography, as well as physical examination of the breasts (CBE and BSE), can detect presymptomatic breast cancer. Because of its demonstrated effectiveness in randomized, controlled trials of screening, film mammography is the standard for detecting breast cancer; in 2002, the USPSTF found convincing evidence of its adequate sensitivity and specificity.

Benefits of Detection and Early Intervention
There is convincing evidence that screening with film mammography reduces breast cancer mortality, with a greater absolute reduction for women aged 50 to 74 years than for women aged 40 to 49 years. The strongest evidence for the greatest benefit is among women aged 60 to 69 years.

Among women 75 years or older, evidence of benefits of mammography is lacking.

Harms of Detection and Early Intervention
The harms resulting from screening for breast cancer include psychological harms, unnecessary imaging tests and biopsies in women without cancer, and inconvenience due to false-positive screening results. Furthermore, one must also consider the harms associated with treatment of cancer that would not become clinically apparent during a woman's lifetime (overdiagnosis), as well as the harms of unnecessary earlier treatment of breast cancer that would have become clinically apparent but would not have shortened a woman's life. Radiation exposure (from radiologic tests), although a minor concern, is also a consideration.

Adequate evidence suggests that the overall harms associated with mammography are moderate for every age group considered, although the main components of the harms shift over time. Although false-positive test results, overdiagnosis, and unnecessary earlier treatment are problems for all age groups, false-positive results are more common for women aged 40 to 49 years, whereas overdiagnosis is a greater concern for women in the older age groups.

The USPSTF has reached the following conclusions:
For biennial screening mammography in women aged 40 to 49 years, there is moderate certainty that the net benefit is small. Although the USPSTF recognizes that the benefit of screening seems equivalent for women aged 40 to 49 years and 50 to 59 years, the incidence of breast cancer and the consequences differ. The USPSTF emphasizes the adverse consequences for most women — who will not develop breast cancer — and therefore use the number needed to screen to save 1 life as its metric. By this metric, the USPSTF concludes that there is moderate evidence that the net benefit is small for women aged 40 to 49 years.

For biennial screening mammography in women aged 50 to 74 years, there is moderate certainty that the net benefit is moderate.

For screening mammography in women 75 years or older, evidence is lacking and the balance of benefits and harms cannot be determined.

Read the full USPSTF report here .

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Mayo Clinic's response to USPSTF's new recommendations.

Mayo Clinic Disagrees with New USPSTF Mammography Screening Guidelines


Mayo task force says women 40 and older should be screened as per usual

ROCHESTER, Minn. — A task force convened by Mayo Clinic in light of the new mammography screening rates recommended by the U.S. Preventive Services Task Force has rejected those guidelines. Mayo Clinic physicians and researchers state that the modeling data used in the analysis, along with input from recent clinical trials conducted outside of the United States, do not constitute strong enough data to change Mayo's practice.

Mayo Clinic will continue to recommend screening mammograms for women age 40 and older. "Every day we discover invasive breast cancer in a woman age 40-50," says Sandhya Pruthi, M.D., director of the Breast Clinic at Mayo Clinic in Rochester, and leader of the task force. Also, elderly women for whom such screening is judged potentially beneficial will continue to receive mammograms. Physicians also will continue to advise their patients to be familiar with their breasts, so that any changes in the tissue can be promptly examined.

The task force acknowledges that annual screening does result in some additional imaging, but patients at Mayo Clinic are generally assessed and evaluated within 24 hours in order to reduce anxiety. Physicians in the Breast Clinic also say that a substantial number of women who receive biopsies because of a screening mammogram are found to have cancer.

Mayo Clinic will continue to evaluate new data on mammography and breast cancer detection as information is made available. But at this time, until a validated method exists that can identify tumors that are slow growing and non-lethal from those that are aggressive, Mayo Clinic physicians feel it is in the best interests of their patients to offer routine screening mammography. And while they further acknowledge that reducing the number of mammograms offered to women, along with follow-up testing, would save healthcare dollars, they do not believe that denying quality care is the way to do it.

About Mayo Clinic
Mayo Clinic is the first and largest integrated, not-for-profit group practice in the world. Doctors from every medical specialty work together to care for patients, joined by common systems and a philosophy of "the needs of the patient come first." More than 3,700 physicians, scientists and researchers and 50,100 allied health staff work at Mayo Clinic, which has sites in Rochester, Minn., Jacksonville, Fla., and Scottsdale/Phoenix, Ariz. Collectively, the three locations treat more than half a million people each year. To obtain the latest news releases from Mayo Clinic, go to www.mayoclinic.org/news . For information about research and education visit www.mayo.edu . The MayoClinic.com site is available as a resource for your health stories.

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The American Cancer Society's response to USPSTF's new recommendations.

American Cancer Society Responds to Changes to USPSTF Mammography Guidelines


The American Cancer Society guidelines will not change; annual mammography recommended for women 40 and over

Atlanta, November 16, 2009 — The United States Preventive Services Task Force (USPSTF) today announced that it is changing its guidelines for mammography and no longer recommends routine screening for women between the ages of 40 and 49. Below is a statement from Otis W. Brawley, M.D., chief medical officer, American Cancer Society.

"The American Cancer Society continues to recommend annual screening using mammography and clinical breast examination for all women beginning at age 40. Our experts make this recommendation having reviewed virtually all the same data reviewed by the USPSTF, but also additional data that the USPSTF did not consider. When recommendations are based on judgments about the balance of risks and benefits, reasonable experts can look at the same data and reach different conclusions.

"In 2003, an expert panel convened by the American Cancer Society conducted an extensive review of the data available at the time, which was not substantially different from the data included in the current USPSTF review. Like the USPSTF, the Society's panel found convincing evidence that screening with mammography reduces breast cancer mortality in women ages 40-74, with age-specific benefits varying depending on the results of individual trials and which trials were combined in meta-analyses. And like the USPSTF, the American Cancer Society panel also found that mammography has limitations — some women who are screened will have false alarms; some cancers will be missed; and some women will undergo unnecessary treatment. These limitations are somewhat greater in women in their forties compared with women in their fifties, and somewhat greater in women in their fifties compared with women in their sixties. We specifically noted that the overall effectiveness of mammography increases with increasing age. But the limitations do not change the fact that breast cancer screening using mammography starting at age 40 saves lives. "As someone who has long been a critic of those overstating the benefits of screening, I use these words advisedly: this is one screening test I recommend unequivocally, and would recommend to any woman 40 and over, be she a patient, a stranger, or a family member.

"The USPSTF says that screening 1,339 women in their 50s to save one life makes screening worthwhile in that age group. Yet USPSTF also says screening 1,904 women ages 40 to 49 in order to save one life is not worthwhile. The American Cancer Society feels that in both cases, the lifesaving benefits of screening outweigh any potential harms. Surveys of women show that they are aware of these limitations, and also place high value on detecting breast cancer early.

"With its new recommendations, the USPSTF is essentially telling women that mammography at age 40 to 49 saves lives; just not enough of them. The task force says screening women in their 40s would reduce their risk of death from breast cancer by 15 percent, just as it does for women in their 50s. But because women in their 40s are at lower risk of the disease than women 50 and above, the USPSTF says the actual number of lives saved is not enough to recommend widespread screening. The most recent data show us that approximately 17 percent of breast cancer deaths occurred in women who were diagnosed in their 40s, and 22 percent occurred in women diagnosed in their 50s. Breast cancer is a serious health problem facing adult women, and mammography is part of our solution beginning at age 40 for average risk women.

"The American Cancer Society acknowledges the limitations of mammography, and we remain committed to finding better tests, and currently are funding a large study to improve the accuracy of mammography. In fact, data show the technology used today is better than that used in the studies in this review, and more modern studies show that mammography is achieving better results than those achieved in these early experimental studies that go back as far as the mid-60's. And as scientists work to make mammography even more effective, the American Cancer Society's medical staff and volunteer experts overwhelmingly believe the benefits of screening women aged 40 to 49 outweigh its limitations."

The American Cancer Society combines an unyielding passion with nearly a century of experience to save lives and end suffering from cancer. As a global grassroots force of more than three million volunteers, we fight for every birthday threatened by every cancer in every community. We save lives by helping people stay well by preventing cancer or detecting it early; helping people get well by being there for them during and after a cancer diagnosis; by finding cures through investment in groundbreaking discovery; and by fighting back by rallying lawmakers to pass laws to defeat cancer and by rallying communities worldwide to join the fight. As the nation's largest non-governmental investor in cancer research, contributing about $3.4 billion, we turn what we know about cancer into what we do. As a result, more than 11 million people in America who have had cancer and countless more who have avoided it will be celebrating birthdays this year. To learn more about us or to get help, call us anytime, day or night, at 1-800-227-2345 or visit cancer.org .

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