Medical Experts Fail to Agree on Mammogram Guidelines

Conflicting advice from medical experts regarding mammograms cause confusion.
Conflicting advice from medical experts regarding mammograms cause confusion.

By Stephanie Golden

Women remain confused about mammograms as leading medical organizations failed to reach a consensus this week.

“Given the differences among current organizational recommendations on breast cancer screening, we recognize that there may be confusion among women about when they should begin screening for breast cancer,” said Dr. Mark DeFrancesco, president of the Washington D.C.-based American College of Obstetricians and Gynecologists, a trade group.
Late last month, the college called for the consensus conference to try to develop uniform guidelines for breast cancer screening. The decision to hold the meeting was made after the U.S. Preventative Task Force issued a set of recommendations for breast cancer screening that conflicted with those from other organizations.

The U.S. Preventative Services Task Force said mammograms should be performed every other year for women ages 50 to 74. The American College of Obstetricians and Gynecologists recommends the test to begin at age 40 and be done every year while the American Cancer Society said it should start at age 45. The society recommends a mammogram every year until the age 55 and then every two years.

Confusion over when to have mammograms continues for women.

“I think the recommendation is that you get them starting at age 40,” said Chicagoan Jevon Dudley, 33. “I also think they say you should have a mammogram done every two years.”

Anessa Swafford, 45, a software engineer from Pittsburgh, said she isn’t sure what age women should start getting a mammogram or how often.

“I thought women were supposed to start getting mammograms every year when they turn 40 or 46,” Swafford said. “I think I heard that doctors are recommending now that you get a mammogram every year starting at age 50.”

The  American College of Obstetricians and Gynecologists convened a consensus to develop a consistent set of uniform guidelines for breast cancer screening. The college called for the conference after the U.S. Preventative Task Force issued a conflicting set of recommendations for breast cancer screening.

According to the American College of Obstetricians and Gynecologists, topics discussed at the conference included when screening for breast cancer should begin, how frequently should a mammogram be performed and if there is a point in a woman’s life that mammographic screening is no longer beneficial. However, representatives from organizations such as the U.S. Preventive Services Task Force, American Cancer Society and the American College of Obstetricians and Gynecologists could not agree on a uniformed set of guidelines.

“The participants will continue the efforts at addressing breast cancer screening recommendations,” the college said in a statement released earlier this week. “It is hoped that the outcome of these conversations will help to improve informed decision-making among women and their health care providers.”

The conflicting guidelines issued by the U.S. Preventative Services Task Force last month spurred the college to host the consensus conference.

The task force, an independent, volunteer panel of national experts in prevention and evidence-based medicine,  recommends that women between the ages of 40 and 49 should consult their doctor for an individualized screening plan. Screening mammography every two years is suggested for women between the ages of 50 and 75. For women over the age of 75 there is no specific recommendation.

The American Cancer Society guidelines state women with an average risk of breast cancer should begin yearly mammograms at age 45. However, they do state that women who desire to start screening at age 40 to speak with their healthcare provider. The organization recommends that women should get a mammogram every two years starting at age 55 as long as they are in good health.

The guidelines for the American College of Obstetrics and Gynecologists slightly differs from the other two organizations. The ACOG is advising women to have a screening mammography every year beginning at the age of 40.

Experts agree that regular mammograms are the best way available to doctors to detect breast cancer early. A mammogram can identify breast cancer up to three years before it can be felt through a self-exam or one performed by a medical provider. When breast cancer is found early, it is easier to treat and many women recover from the disease.

Dr. Anees Chagpar, an associate professor of surgical oncology at Yale School of Medicine, said guidelines evolve as health experts evaluate the data in terms of risks and benefits. She said the conflicting advice on breast screening mammography should not overshadow its role.

“Hopefully, the recommendations affect women only in terms of having meaningful conversations with their doctors about risks and what tests are right for them,” said Chagpar. “Women should not interpret the new guidelines as diminishing the importance of mammography.”

According to the American College of Obstetricians and Gynecologists, the guidelines are for women who are at average risk only.  A woman with a strong family history of breast cancer should talk to her doctor for an individualized screening plan.

Photo at top: Conflicting breast screening mammography guidelines still confuse women. (Melanie/Creative Commons)