New Mammography Guidelines Issued for Women 40-49

American College of Physicians suggests exam timetable should be based on discussion with doctor

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HealthDay Reporter

MONDAY, April 2, 2007 (HealthDay News) -- New mammography guidelines for women 40 to 49 years old suggest that any decision to undergo the exam should be based on a discussion between a woman and her doctor.

The guidelines come from the American College of Physicians, one of several medical groups that have put forward ideal intervals for mammography screenings for breast cancer. However, there's no consensus among the groups for women in their 40s.

"I hope what (the new guidelines) will do is allow women to have the sorts of conversation that discusses for them personally, the risks and benefits of a screening mammogram," said Dr. Lynne Kirk, president of the American College of Physicians.

The discussion should ideally include a family history of breast cancer, whether the woman has had a previous breast biopsy to check for cancer, and other factors, added Kirk, a professor of internal medicine at the University of Texas Southwestern Medical Center at Dallas.

"We had not done a specific recommendation on women 40 to 49," she said. "We had recommended for women 50 and over, every year or every other year."

Kirk said she doesn't think the new guidelines will discourage women from having the exam. "My guess is, a lot of women will choose to have a mammogram based on this discussion," she said.

Among the risks of mammogram for younger women is the possibility of undue anxiety when a test result is questionable and the patient is sent for a biopsy, and that biopsy produces a false-positive result, Kirk said. "That risk is certainly much higher in low-risk women 40 to 49," she said.

The college committee in charge of drafting the guidelines reviewed 117 studies to evaluate the evidence on the risks and benefits of mammography screening for women in the 40-to-49 age group.

In an editorial accompanying the guidelines, the authors concluded that "no simple recommendation applies to all women in their 40s." The best strategy, they wrote, is for physicians to listen carefully to patients and to communicate to them "the benefits and limitations of our imperfect tests."

The new guidelines, meant to be used by practicing physicians, are published in the April 3 issue of the Annals of Internal Medicine,, a publication of the American College of Physicians.

The new guidelines don't mesh with some recommendations issued by other medical groups. In 2006, American Cancer Society recommended annual mammograms for women beginning at age 40. And the U.S. Preventive Services Task Force recommends screening mammography every one to two years for women 40 and older, noting there wasn't enough evidence to specify the best screening interval for women 40 to 49.

Dr. Cheryl Perkins, senior clinical adviser for Susan G. Komen for the Cure, a Dallas-based organization devoted to fighting breast cancer, said setting mammogram guidelines for women in the 40-to-49 age range is difficult.

"It's a very diverse age group," she said. "Some are still child-bearing, some are perimenopausal, some are menopausal."

Perkins said the new American College of Physicians' guidelines "won't trigger a change in our recommendations at this point in time. We continue to recommend annual screening for women 40 and over."

"Cancer that occurs in women still in their childbearing years can be more aggressive than cancers in the postmenopausal group," she added.

Breast cancer is the most common cancer among women, other than skin cancer. It's the second-leading cause of cancer death in women, after lung cancer. An estimated 178,000 women in the United States will be diagnosed invasive breast cancer in 2007, and about 40,000 women will die from the disease this year, according to the American Cancer Society.

More information

To learn more about mammography, visit Susan G. Komen for the Cure.

SOURCES: Cheryl Perkins, M.D., senior clinical adviser, Susan G. Komen for the Cure, Dallas; Lynne Kirk, M.D., president of the American College of Physicians, and professor of internal medicine, University of Texas Southwestern Medical Center at Dallas; April 3, 2007, Annals of Internal Medicine

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