For decades, enduring a mammogram was a rite of passage for women turning 40.
Absent symptoms or genetics that would trigger screening at an earlier age, women knew reaching the four-decade mark meant they’d soon face getting squeezed in a machine for their own good.
But evolving recommendations from the American Cancer Society and from an influential federal task force on preventive medicine now hold that it’s better to wait until age 45 or even 50 to start having routine mammograms.
That changing guidance and a related debate about how often women in different age groups should be screened with the breast X-rays can confound patients, for whom preventative screening is often only a first step in a dizzying array of options for breast cancer care.
“It can be really confusing even for their physicians,” said Gretchen Smith, a radiologist specializing in breast diagnosis and intervention with Sutter Medical Group of the Redwoods. “It’s a moving target.”
On one point, consensus exists among doctors, researchers and public health officials: Mammography saves lives and should be available to all women by age 50, if not earlier, to detect signs of a disease that affects one in eight women, killing more than 40,000 American women a year.
Locally, many health care providers still advise patients who are at normal risk for breast cancer to get baseline mammograms at age 40 and to have one every year or every other year thereafter.
Each cancer caught early, each additional life spared, makes any downsides of early screening worthwhile, they argue. Many national professional associations agree.
“I don’t think, in practice, there’s much controversy” about screening women of ages 40 to 49, said Yung Do, a radiologist with Kaiser Permanente in Santa Rosa. “I think most clinicians I talk to, in practice, we see enough breast cancers between that age group that we feel like there’s a lot of value in (screening) that age group.”
But the shifting guidelines mean women and their health care providers must navigate conflicting advice in an area that already provokes apprehension and fear among patients. In addition, doctors like Smith, a strong advocate of starting mammograms at 40, can find themselves at odds with the facility where they work. Sutter Health, where Smith practices, recommends women generally wait until age 50.
The discrepancies could have implications for how much routine imaging insurance companies cover in the future.
Guidelines issued by the U.S. Preventive Services Task Force, an expert panel convened by the federal Agency for Healthcare Research and Quality, a division of the U.S. Department of Health and Human Services, provide the framework for preventive screening and treatment that American health insurers are required to cover at no cost to their clients.
That task force now says women should start screening mammograms at 50 and have them only every other year through age 74.
It said the “balance of benefits and harms” doesn’t pencil out in a way that suggests younger women should be screened.
“While screening mammography in women aged 40 to 49 years may reduce the risk for breast cancer death,” the panel said, “the number of deaths averted is smaller than that in older women and the number of false-positive results and unnecessary biopsies is larger.”
‘Harms’ in screenings