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Mammograms: More New Screening Guidelines
The American College of Obstetricians and Gynecologists now recommends annual screening beginning at age 40.
Previous guidelines from the American College of Obstetricians and Gynecologists (ACOG) recommended screening every 1 to 2 years for women in their 40s and annual screens beginning at age 50 (JW Womens Health Apr 21 2011). Now, two critical observations have provided the underpinnings for the ACOG's decision to recommend annual screening for women in their 40s:
•Mean sojourn time (the period during which tumors can be detected by screening before they become symptomatic) is shorter in women who are younger than 50 compared with older women. More-aggressive tumors characteristically have shorter sojourn times.
•Reductions in mortality associated with screening are similar for women in their 40s and 50s.
More-frequent screening is associated with more false-positive screens. Because of the high rate of false-positive screens and the large number of screens needed to prevent one breast cancer death among women in their 40s, the 2009 U.S. Preventive Services Task Force guidelines recommended that routine screening mammography be deferred until women reach age 50 and that screening be biennial (JW Womens Health Nov 16 2009). The new ACOG guidance acknowledges these concerns as well as the potential for false-positive mammograms to cause anxiety. Nonetheless, the ACOG also points out that U.S. women generally cope well with such anxiety.
The ACOG continues to recommend clinical breast exams annually for women who are aged 40 and every 1 to 3 years for younger women (age range, 20–39). In addition, the ACOG encourages breast self-awareness for women who are aged 20.
Comment: In discussing screening mammograms with patients, we should be candid about the potential for false-positive findings and their attendant diagnostic imaging and biopsy implications. Advising women in their 40s that false-positive screens are particularly common at their age is appropriate. Ultimately, our patients will be best served if we make recommendations about breast screening in a flexible, non-judgmental manner that is sensitive to their personal values as they attempt to balance the benefits of screening against the risks associated with false-positive results.
— Andrew M. Kaunitz, MD
Published in Journal Watch Women's Health July 28, 2011
Citation(s):
ACOG Committee on Practice Bulletins–Gynecology. Practice Bulletin No. 122: Breast cancer screening. Obstet Gynecol 2011 Aug; 118:372. ([Ссылки доступны только зарегистрированным пользователям ])
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