American College of Obstetrics and Gynecology Urges Annual Mammograms Starting at Age 40

In an effort to reduce breast cancer deaths, especially in young women, the American College of Obstetricians and Gynecologists recently updated its breast screening guidelines.

The primary change is that doctors now say that mammography screening should be offered annually to women beginning at age 40. The previous ACOG guidelines recommended women have mammograms every one to two years, beginning at age 40 and then receive them every year, beginning at age 50.

This is in stark contrast to the recommendations made by the US Preventive Services Task Force almost two years ago. It recommended women in their 40s should not get routine mammograms. The group, made up of 16 health care experts, none of whom were oncologists, suggested that before having a mammogram, women ages 40 to 49 talk to their doctors about the risks and benefits of the test, and then decide whether to be screened.

“All we are saying is, at age 40, a woman should make an appointment with her doctor and have a conversation about the benefits and harms of having a mammography now versus waiting to age 50,” Dr. Diana Petitti, vice chair of the task force, was quoted as saying when their recommendations were announced.

But ACOG researchers, who had been working on the new guidelines when the task force published its announcement in November 2009, didn’t agree.

“Although we believe a woman should always talk to her doctor, there is strong evidence there’s a need for early screening,” said Dr. Jennifer Griffin, co-author of the ACOG guidelines. “We know that 40,000 women in the US, every year, contract breast cancer in their 40s. Of those, 20% will die,” Griffin continued. “In our decision making process we felt it was our job to help women make the best decisions for their physical health. We think it is important women are given opportunities to choose what tests they need.”

ACOG authors said the changes in the screening guidelines were based on three factors: the number of breast cancer cases reported in the US; the sojourn time, or how fast the tumor grows in young patients; and the potential to reduce the number of deaths from breast cancer by using breast screening.

The time period between when a breast cancer may be detected by a mammogram and before it grows big enough to cause problems is known as the sojourn time. Doctors say that although that time can vary in different people, the greatest predictor is age. Women ages 40 to 49 have the shortest average sojourn time (2-2.4 years), while women in their 70s have the longest average sojourn time (4-4.1) years.

According to the American Cancer Society, the five-year survival rate is 98% for women who find their breast cancer tumors early. ACOG researchers believe if women in their40s have access to annual mammograms, there is a better chance of finding their tumors and treating them early before they spread.

“Although women in their 40s have a lower overall incidence of breast cancer compared with older women, the window to detect tumors before they become symptomatic is shorter, on average,” said Griffin.

ACOG also recommended that women 40 and older receive annual clinical breast exams and for those women ages 20-39, the group recommended a breast exam every one to three years, depending on the woman’s family breast cancer history. It also recommended women practice “breast self-awareness.” This is not meant to replace the traditional breast self-exam, but to enhance it by asking women to become more aware of changes in their breasts on a daily basis.

“The goal here is for women to be alert to any changes, no matter how small, in their breasts, and report them to their doctor,” said Griffin. “Although we’ve moved away from routinely recommending breast self-exams, some women will want to continue doing them and that’s OK, because we know that screening tests can miss some breast cancers. Knowing your breasts helps catch breast cancer early.”

Breast cancer is the second leading cause of all cancer-related deaths among American women. The number of breast cancer cases diagnosed in the US has dropped 2% each year between 1999 and 2006, and deaths from breast cancer have also declined steadily over the past 20 years. ACOG believes if women continue with early screening, the number of deaths from breast cancer could be decreased even further.

When asked if the Preventive Services Task force would reconsider its guidelines now that ACOG has weighed in, Karen Migdail, a media representative for the group respresentatives said, “There are no plans to revise our recommendations.”