Women age 40 and older should have access to screening mammography if they choose and their doctors agree, says the American Medical Association (AMA). The policy, adopted after much debate at AMA's June 2012 House of Delegates meeting, stops short of recommending yearly routine screening mammograms for all women starting at age 40. Instead, women are encouraged to discuss and consider the benefits and risks with their doctors before deciding whether to undergo screening.
"Early detection of breast cancer increases the odds of a patient's survival, and mammography screenings are an important tool in discovering this cancer," said AMA board member Patrice A. Harris, M.D. after the policy was adopted. "All patients are different and have varying degrees of cancer risk, and patients should regularly talk with their doctors to determine if mammography screening is right for them."
Different health organizations offer guidance on how and when to screen for various conditions, and they periodically review and modify the recommendations based on what they see is the best evidence of benefits and risks. Previously, AMA took a more straightforward stance, supporting annual screening mammograms in all asymptomatic women older than 40. Though no longer advocating annual screening mammograms, AMA's current position aims to assure availability to any asymptomatic women older than 40.
The AMA's latest policy statement is similar to the 2009 U.S. Preventive Services Task Force (USPSTF) recommendation that screening mammography in women younger than 50 be offered only “if other considerations support [it].” The USPSTF explained its recommendation, noting that "for most individuals without signs or symptoms there is likely to be only a small benefit from this service." The USPSTF, an independent panel of 16 volunteer clinicians, recommends that women ages 50 to 74 get mammograms every 2 years. Any decision that a younger woman should get a mammogram should take into account "the patient's values regarding specific benefits and harms," the USPSTF says.
Although women in their 40s and women in their 50s get equal benefit from routine screening mammography, the younger women experience greater harms because they are more likely to have dense breasts that are difficult to assess during mammography, resulting in a higher rate of false positives, the USPSTF explains. Additional imaging and other tests ordered based on false results expose women to unnecessary risk, the panel adds.
Recommendations from number of other medical groups, including the American Cancer Society (ACS) and the American College of Obstetricians and Gynecologists (ACOG), differ from those of the USPSTF and say women younger than 50 benefit from having routine mammograms.
Women should get screening mammograms beginning at age 40 because the tests can potentially identify cancerous masses before they can be felt, say 2011 ACOG breast cancer screening guidelines. The period when cancers are too small to feel upon exam is called sojourn time, when treatment options may be greater and outcomes improved, the ACOG guidelines note. The sojourn time is generally shorter in younger women, they add.
ACS echoes ACOG's recommendation for mammograms beginning at age 40, but notes some of the concerns stated by the USPSTF. "Women can feel confident about the benefits associated with regular mammograms for finding cancer early," ACS says. “However, mammograms also have limitations. A mammogram will miss some cancers, and it sometimes leads to follow up of findings that are not cancer…” These follow-up procedures may include biopsies.
As with any screening test, women younger than 50 who are considering breast cancer screening should talk to their doctors about benefits, limitations, and potential harms and should understand that mammograms can miss some cancers. "But despite their limitations, they [mammograms] remain a very effective and valuable tool for decreasing suffering and death from breast cancer," ACS concludes.
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Press Release. AMA Adopts New Policies at Annual Meeting. American Medical Association. Available online at http://www.ama-assn.org/ama/pub/news/news/2012-06-19-ama-adopts-new-policies.page through http://www.ama-assn.org. Issued June 19, 2012. Accessed June 29, 2010.
AMA Supports Access to Mammography for Women Older than 40. AMNews. Available online at http://www.ama-assn.org/amednews/site/house-more.htm#refe through http://www.ama-assn.org. Published June 19, 2012. Accessed June 29, 2012.
Emily P. Walker. AMA Bucks USPSTF on Mammography. MedPage Today. Available online through http://www.medpagetoday.com. Published June 19, 2012. Accessed June 29, 2012.
Screening for Breast Cancer: Recommendation Statement. U.S. Preventive Services Task Force. Available online at http://www.uspreventiveservicestaskforce.org/uspstf09/breastcancer/brcanrs.htm/ through http://www.uspreventiveservicestaskforce.org. Last updated December 2009. Accessed June 29, 2012.
United States Preventive Services Task Force. Breast Cancer Screening. Available online at http://www.uspreventiveservicestaskforce.org/uspstf/gradespost.htm#crec through http://www.uspreventiveservicestaskforce.org. Accessed July 2012.
Well-Woman Care: Assessments & Recommendations. American College of Obstetricians and Gynecologists (ACOG). Available online through http://www.acog.org. Last updated March 29, 2012. Accessed June 29, 2012.
Practice Bulletin: Breast Cancer Screening. American College of Obstetricians and Gynecologists. Available online at http://journals.lww.com/greenjournal/Citation/2011/08000/Practice_Bulletin_No__122__Breast_Cancer_Screening.40.aspx through http://journals.lww.com. Issued August 2011. Accessed June 29, 2012.
Interpreting the U.S. Preventive Services Task Force Breast Cancer Screening Recommendations for the General Population. ACOG. Available online at http://www.acog.org/About_ACOG/News_Room/News_Releases/2009/Interpreting_the_US_Preventive_Services_Task_Force through http://www.acog.org. Published November 16, 2009. Accessed June 29, 2012. (Updated December 2009)