Trying to decide when to start and how often to have a routine mammogram can make your head spin. It used to be easy: starting at 40 have an annual mammogram. End of discussion.
Now, the major medical groups we have long relied on to tell women what to do about breast cancer screening aren't in complete agreement when it comes to women of average risk — that's the majority of us who have never had breast cancer and who don't have a mother, sister or child who had the disease. High-risk women have their own set of guidelines, which includes annual mammograms and breast MRI beginning as early as age 25 for some.
The major medical groups that issue general breast screening recommendations include the U.S. Preventive Services Task Force, the American Cancer Society, the American College of Obstetricians and Gynecologists and the American College of Radiology. (There are more groups, and you can see all their recommendations at the Centers for Disease Control and Prevention website: tbtim.es/guidelines.)
Some of the highlights:
The Preventive Services Task Force recommends screening every other year starting at age 50. If a woman wants to start earlier, between ages 40 and 49, the task force says the option should be available — but only every other year, like the older group.
The American Cancer Society recommends annual screening for women starting at age 45, but if women want to begin earlier, at age 40 to 44, the option should be available. At age 55 and older the ACS says screening every other year is sufficient, but if a woman wants annual screening after age 55, the option should be available.
The American College of Obstetricians and Gynecologists and the American College of Radiology recommend annual screening beginning at age 40. ACOG also recommends an annual clinical breast exam through age 74.
Got that? And we haven't even addressed what the American Academy of Family Physicians and the American College of Physicians recommend. Nor have we covered the recommendations for women older than age 75.
"I see women every day who complain about the confusion around when to begin and how often to have screening mammograms," said Dr. Bethany Niell, a diagnostic radiologist in the Department of Diagnostic Imaging and Interventional Radiology at Moffitt Cancer Center. "My fear is that women will stop getting mammograms altogether because of the confusion. Screening every year starting at age 40 saves more lives."
Niell cited research which found that screening annually starting at age 40 saves an additional 65,000 lives each year, compared to starting screening at age 50. She also worries that the changes in screening recommendations may affect insurance coverage of mammograms.
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"If these professional organizations disagree, it could affect access to this lifesaving intervention," Niell said. "Coverage under the Affordable Care Act is linked to the U.S. Preventive Services Task Force recommendation. So, if women age 50 to 74 want annual screening, they may not be guaranteed coverage."
The one point that most groups and physicians agree on is that women need to speak with their physicians to determine when they should start and how often to have mammograms.
"I agree that it can be confusing for patients," said Dr. Laura Arline, a primary care specialist in the BayCare Medical Group. "But, when you have that discussion and lay out all the guidelines and the risks and the benefits, women have been really good about knowing what they want to do."
Arline, who as a primary care doctor refers patients for health screenings such as mammograms, takes into consideration the woman's age, current health status, her family history of breast and other cancers, and her comfort level with each set of recommendations.
"Some women are okay with waiting until they're 50 to start screening. Others aren't," Arline said. "I lay out the information and she makes a choice with my input. It's our job as primary care providers to help patients figure out the best decision for them. It's an important discussion to have."