New Screening Mammography Guidelines Affect
Women in Their Forties
< Apr.
04, 2007 > -- Not all women in their
40s should be routinely screened for breast cancer,
says the American College
of Physicians (ACP).
New mammography guidelines issued
by the ACP 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 physician.
The ACP is
one of several medical groups that have put forward
ideal intervals for mammography screenings for breast
cancer. However, there is no consensus among the
groups for women in their 40s.
For example, the American
Cancer Society (ACS) recommends annual mammograms
for women beginning at age 40. The National
Cancer Institute (NCI) recommends that women
in their 40s and older should have a screening
mammogram on a regular basis, every one to two
years. And the US Preventive
Services Task Force recommends screening
mammography every one to two years for women 40
and older, noting there was not enough evidence
to specify the best screening interval for women
40 to 49.
Breast cancer is the most common
cancer among women, other than skin cancer. It is
the second-leading cause of cancer death in women,
after lung cancer. An estimated 178,000 women in
the US will be diagnosed with invasive breast cancer
in 2007, and about 40,000 women will die from the
disease this year, according to the American
Cancer Society.
ACP developed
the guideline to present the available evidence for
screening mammography to physicians and women between
the ages of 40 and 49 and to increase their understanding
of the benefits and risks of screening mammography
in women within this age group.
"We designed our screening mammography
guideline based on scientific evidence," says Dr.
Lynne Kirk, president of ACP. "It
will empower women between the ages of 40 and 49
to become part of the decision-making process and
to encourage them to discuss with their physicians
the benefits and risks of mammograms."
The guideline states that, according
to the evidence studied, breast cancer risk is not
evenly distributed in women between the ages of 40
and 49. Thus the benefits of screening mammography
are not uniformly applicable in women in this age
group. Therefore, women 40 to 49 years of age need
to take into account their level of risk and the
possible benefits and harms of screening mammography.
"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," says Dr. Kirk.
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, adds Dr. 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 says. "We had recommended
for women 50 and over, every year or every other
year."
Dr. Kirk says she does not 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
says.
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, Dr. Kirk says. "That risk
is certainly much higher in low-risk women 40 to
49," she says.
The ACP 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 conclude that "no simple
recommendation applies to all women in their 40s." The
best strategy, they write, 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 Annals
of Internal Medicine, a publication of the ACP.
Dr. Cheryl Perkins, senior clinical
adviser for Susan G. Komen
for the Cure, a Dallas-based organization
devoted to fighting breast cancer (formerly known
as the Susan G. Komen Breast
Cancer Foundation), said setting mammogram
guidelines for women in the 40-to-49 age range is
difficult.
"It's a very diverse age group," she
says. "Some are still child-bearing, some are perimenopausal,
some are menopausal."
Dr. Perkins says the new ACP 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 adds.
Always consult your physician
for more information. |
