E-News Exclusive

Did 2009 Guidelines Reduce Mammograms in Younger Women?
By Jim Knaub

Who decides when most women should begin having mammograms? Breast care specialists, the American College of Radiology, the American Cancer Society (ACS), and the U.S. Preventive Services Task Force (USPSTF) have weighed in with their views.

The ACS, ACR, and many breast care specialists recommend that women at normal risk of breast cancer begin annual mammography screening at age 40. In 2009, the USPSTF recommended that these women at begin screening at age 50 and have mammograms every two years. Before age 50, the USPSTF recommends that women discuss with their doctors the risks and benefits of mammograms and decide whether to have one. The difference between those recommendations prompted heated debate in 2009 that has quieted and flared up again since then.

The latest round of the debate came in response to a study at University Hospitals at Case Medical Center in Colorado showing that 205 fewer women aged 40 to 49 had mammograms at the medical center in the nine months following the 2009 USPSTF guidelines.

So what’s behind the drop? That’s the question.

Consider the following:

  • Are fewer physicians recommending their patients begin breast cancer screening at age 40?
  • Are women making a conscious decision that the modest benefit of screening is not worth the risks of unnecessary biopsy, radiation exposure, and the anxiety about false- positives?
  • Is confusion about the different recommendations keeping women from coming in forto undergo the test?
  • Are women using the new guidelines as an excuse to not have a mammogram?

No one knows the answers, but there are strong views on the matter.

“Seventy percent of women who are diagnosed with breast cancer don't have a family history of breast cancer,” said Donna Plecha, MD, a coauthor of the study and director of breast imaging at Case Medical Center, in a statement released with the study. "It's very important that we continue to do all that we can to catch breast cancer in the earliest stages so that we can continue to save lives."

On the other side of the issue is Virginia A. Moyer, MD, MPH, who chairs the USPSTF committee that released the controversial 2009 guidelines. “The benefit in 40- to 49-year-old women is pretty small," Moyer told CNN. “There is a real but rather modest benefit. There are also risks.”

The risks of false positives and radiation exposures are worth women and their doctors’ consideration. But there is legitimate concern that the drop in mammograms performed on younger women may have been for reasons other than a conscious decision after weighing the pros and cons of the test. It’s one thing for women to decide on their own to delay mammography screening, but having mammography rates drop because of some unintended consequence is something else entirely.

— Jim Knaub is editor of Radiology Today.