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Controversial mammogram guidelines largely ignored

Kathleen Blanchard's picture
Controversial 2009 guidelines for mammogram seem to have been ignored.

Are women still getting their mammograms before age 50, despite 2009 recommendations from the United States Preventative Services Task Force (USPSTF)?
A new analysis shows the guidelines issued three years ago have been largely ignored, though the reasons are unclear.

A study from Brigham and Women's Hospital (BWH) finds that mammogram rates in the United States have not declined among women age 40 to 49 in the past 3 years and rose just slightly.

Mammogram guidelines 2009

The USPSTF consists of a panel of medical experts, who in 2009 reviewed medical literature to find out at what age a woman should begin mammogram testing. The group compiled data from more than 600,000 women from the U.S. Breast Cancer Surveillance Consortium and then developed a mathematical model to compare various breast cancer screening methods include self-exam, MRI, traditional and digital mammography and clinician breast exam.

The conclusion was that there was not enough evidence to recommend traditional mammogram screening for breast cancer before age 50. The task force recommended against self-breast exam, found no evidence for superiority of MRI or digital mammography and suggested women age 50 to 79 get their screening every other year.

The task force took into account lower rates of breast cancer that tends to occur after menopause. They also cited the angst and extra cost of false positive mammograms that can interfere with quality of life for women awaiting definitive answers while undergoing additional testing.

Waiting two years between screenings was recommended because the task forced said most breast cancers are not aggressive.

The new guidelines stirred some debate.

Younger women still getting screened

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Despite the recommendations, the USPSTF says little has changed. Lydia Pace, MD, MPH, a global women's health fellow in the Division of Women's Health at BWH said younger women are still getting their mammograms, based on the analysis that showed no decline in overall rates of the study.

The study included data from 28,000 women who were questioned about mammography use during the 2005, 2008 and 2011 from the Center for Disease Control's National Health Interview Survey.

Instead of declining, mammography rates rose slightly, but the increase was not statistically significant.

Dr. Pace says the study does not explain why breast cancer screening at a younger age remains steady, despite the USPSTF study and following recommendations. It could be because there was some disagreement about the guidelines from professional breast cancer advocacy groups.

The American Cancer Society has continued to advocate that women age 40 and older have annual screenings.

Pace says, it could also be that physicians disagree with the guidelines.

Breast cancer screening at age 50 and annually have also been ignored by insurance companies. Mammograms are still covered as a preventive screening under private insurance and Medicare. Advantage policies.

Based on the finding, younger women might also be in disagreement with the expert recommendations that waiting until age 50 for breast cancer testing is safe They may be referring themselves directly to radiology facilities for their mammograms. The USPSTF is scheduled to review the issue of when and how often women should have their breast cancer screening again in 2014.

Journal Cancer
April 19, 2013

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