Breaking News: Initiate Mammography Screening at 50, not 40, Says USPSTF.

November 17, 2009

mammogram_showing_breast_cancerAalok Turakhia, MD

As the debate over when to begin screening mammography in women rages on, the United States Prevention Service Task Force (USPSTF) added fuel to the fire by releasing a new recommendation statement in the November 17th issue of the Annals of Internal Medicine.  Applying to women aged ≥40 who are not at an increased genetic risk or have had chest irradiation, the USPSTF now recommends biennial screening in women between ages 50-74.  In February 2002, the task force first recommended that annual or biennial screening start at age 40; however, in a revised statement, “The USPSTF recommends against routine screening mammography in women aged 40 to 49 years.”  It adds, “The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take into account patient context, including the patient’s values regarding specific benefits and harms.”  Additionally, regarding screening mammography in women 75 years or older, the evidence is lacking and the risk/benefit ratio has not been fully determined.

Predictably, there has been both supporting and dissenting response from the medical community.  In a statement from the American Cancer Society released yesterday, it “continues to recommend annual screening using mammography and clinical breast examination for all women beginning at age 40.”  The chair of the American College of Radiology’s Breast Imaging Commission had a more stern tone in her response.  Dr. Carol Lee stated, “These unfounded USPSTF recommendations ignore the valid scientific data and place a great many women at risk of dying unnecessarily from a disease that we have made significant headway against over the past 20 years.”  However, the National Breast Cancer Coalition, Breast Cancer Action, and the National Women’s Health Network, all supported the newly released USPSTF guidelines.

There is little doubt that the recommendations would result in billions of dollars of savings in medical costs, and though there are always charges of political motivation when guidelines such as these are released, physicians should always use clinical acumen and adequately weigh the pros and cons of what promises to be continuous topic of discussion and debate.

Brawley, OW. American Cancer Society Press Room. 16 11 2009. 17 11 2009

Casey, B. “USPSTF ups mammography screening age to 50.” 16 11 2009. Aunt Minnie. 17 11 2009

Kolata, Gina. “Panel Urges Mammograms at 50, Not 40.” 16 November 2009. The New York Times . 17 November 2009 <>.

U.S. Preventative Services Task Force. “Screening for Breast Cancer: U.S. Preventive Services Task Force Recommendation Statement.” Annals of Internal Medicine (2009): 716-726.

Image Courtesy Wikimedia Commons


2 Responses to Breaking News: Initiate Mammography Screening at 50, not 40, Says USPSTF.

  1. Amar Bansal on November 17, 2009 at 9:28 pm

    It’s interesting to see how politicians are interpreting this change in guidelines. See the NY Times link for a rather cynical view offered by one Congressman.

    http://prescriptions.blogs.nytimes.com/2009/11/17/republicans-say-cancer-screening-guidelines-portend-medical-rationing/

  2. Loren Greene on November 18, 2009 at 5:45 pm

    I don’t understand who or what constitutes this new agency. I do not think it has any government basis. Is it underwritten by the insurance industry? In their conclusions, they acknowledge that a few lives might be lost for cost-saving. I do not know how this might be justified. Mammography, breast ultrasound, and breast biopsy are relatively safe and lower cost procedures, though maybe the argument should center around the cost, rather than to make it difficult for women under age 50 to obtain these procedures. My concern is that it will affect doctors who are concerned enough about their patients to request a mammogram, but who are under age 50, or who require testing more than once every two years, to have to spend time, to fight the hurdles of radiology clearing houses (like Care Core). Do we have the time for this? Do we have the resources for this fight for our patients? I do not see a good statistical analysis of how this benefits anyone. And, in this day, when we want to encourage patients to increase awareness and to take on some of the self-care responsibilities, to discourage self-examination? I don’t see how this is acceptable.

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