Differences Among Doctors Remain: When Should Women Start Getting Mammograms?


Many primary care doctors and gynecologists today say they still recommend yearly mammograms for women in their early 40s — despite prevailing recommendations pushing back the age for the breast cancer screening practice, according to a new paper.

In the new survey, 81 percent of physicians said they recommend annual screening for women ages 40 to 44, while over two-thirds suggest regular mammograms for those ages 75 and above.

What Doctors Practice Despite Mammogram Guideline Changes

Experts remain divided on the frequency of screenings that prove beneficial. According to the American Congress of Obstetricians and Gynecologists, annual mammograms should start at 40 years old for all women, while the U.S. Preventive Services Task Force push for biennial screening starting age 50.

The American Cancer Society, on the other hand, updated its guidelines in 2015 to recommend yearly screening starting age 45 and screening every other year from age 55 and beyond.

“Gynecologists were, in general, more likely to recommend routine mammograms,” concluded lead researcher and Johns Hopkins internist Dr. Archana Radhakrishnan.

The new study involved information from 871 primary care doctors and gynecologists in the country who, in a mailed survey from May to September last year, self-declared their breast cancer screening practices.

Radhakrishnan said that despite guideline changes, doctors continue to recommend routine mammograms both to younger and older females. The recommendations vary based on their specialty, where gynecologists are most likely to go for screening, she added.

The findings of this new report run similar to those of a previous one, where 75.7 percent of primary care providers disclosed screening practices beyond those recommended by the USPSTF.

The findings were discussed in the journal JAMA Internal Medicine.

Experts Discuss The Findings

The National Cancer Institute noted that around 12 percent of U.S. women will develop breast cancer at some point in time.

According to Dr. Richard Wender, chief cancer control officer at ACS, all guidelines agree that mammography should start at age 40. The difference actually lies in the age at which screening should be suggested without needing “an informed decision,” he said.

Dr. Debora Grady, who wrote an editorial accompanying the study, found it “disappointing and dispiriting" that a big number of doctors say they do not follow current guidelines.

Debate surrounds mammography recommendations because of evidence that breast cancer takes place so much less often in women in their 40s, meaning the risks could outweigh the purported benefits. In addition, younger women run a higher risk of getting false positives, opening up a whole new set of follow-up procedures.

“The false positive may result in some anxiety for the patient, but it definitely will result in additional testing,” Grady said, referring to biopsy or additional radiation via follow-up scans.

False-alarm mammograms, too, can significantly affect a woman’s attitude toward screening, where she can decide to skip or delay future screening sessions.

The risk of overdiagnosis also remains, she added, where a cancer finding (that actually does not pose immediate risk) is tackled through therapies like lumpectomy and radiation.

A Danish study early this year also found that one in three women with breast cancer detected via mammography is given unnecessary treatment.

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