Despite recommendations from the U.S. Preventive Services Task Force (USPSTF) to postpone mammography screenings until age 50, younger women continue to undergo the routine breast cancer test, according to Johns Hopkins researchers.
The fact that insurance companies continue to pay for these mammograms for women in their 40s is most likely the reason for the persistently high rate of screening, researchers state.
In 2009, the USPSTF recommended that women between the ages of 40 and 49 without a family history of breast cancer should discuss the risks and benefits of routine screening mammographies with their physicians to make individual decisions. They reasoned that routine screening increased rates of detecting cancer detection rates in young women, but only reduced mortality risk by a very small percentage. Instead, the tests were more likely to result in over-diagnosis, and unnecessary treatment, including biopsies, lumpectomies and mastectomies, and weeks of radiation and potentially toxic drugs. And false positives could result in avoidable procedures and psychological trauma.
The task force maintained that women ages 50 through 74 should continue to undergo mammograms every two years because breast cancer, like most cancer, is a disease of aging, and a woman’s risk of breast cancer increases as she grows older.
As a result of the altered recommendations, researchers expected to find fewer women in their 40s getting mammograms. Instead, they found no impact on mammography rates among younger women. They analyzed mammogram use data from nearly 500,000 women ages 40 to 74 administered in 2006, 2008 and 2010 by state health departments nationwide and found that among women in their 40s, 53 percent reported having a mammogram in the past year in 2006 and 2008, compared with 65 percent of women ages 50 to 74. In 2010, after the new recommendations had been in effect, 52 percent of younger women and 62 percent of older women reported having a mammogram.
The original USPSTF guideline change recommended more forcefully against routine screening for women in their 40s, but a political and advocacy group backlash resulted in compromise language that counseled individual decision-making by patients and physicians. The American Cancer Society continues to recommend yearly mammography for women starting at age 40.
The USPSTF recommendations also say there is no benefit to screening women at normal risk of breast cancer over the age of 75.
Source: Johns Hopkins Medicine, May 15, 2013
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