New advice: Mammograms should begin at 50, not 40

NEW YORK (AP) — Most women should wait until age 50 to get mammograms and then have one every two years, a government task force said Monday in a major reversal that conflicts with the American Cancer Society’s long-standing recommendation of annual screening starting at 40.

Also, the task force said that breast self-exams do no good and that women shouldn’t be taught to do them.

For nearly two decades, the cancer society has been recommending regular mammograms beginning at 40.

But the government panel of doctors and scientists concluded that getting screened for breast cancer so early and so often is harmful, causing too many false alarms and unneeded biopsies without substantially improving women’s odds of surviving the disease.

“The benefits are less and the harms are greater when screening starts in the 40s,” said Dr. Diana Petitti, vice chairwoman of the panel.

The new guidelines were issued by the U.S. Preventive Services Task Force, whose stance influences coverage of screening tests by Medicare and many insurance companies. But Susan Pisano, a spokeswoman for America’s Health Insurance Plans, an industry group, said insurance coverage isn’t likely to change because of the new guidelines. No changes are planned in Medicare coverage either, said Dori Salcido, spokeswoman for the Health and Human Services department.

Experts expect the revisions to be hotly debated and to cause confusion for women and their doctors.

“Our concern is that as a result of that confusion, women may elect not to get screened at all. And that, to me, would be a serious problem,” said Dr. Len Lichtenfeld, the cancer society’s deputy chief medical officer.

The guidelines are for the general population, not those at high risk of breast cancer because of family history or gene mutations that would justify having mammograms sooner or more often.

The new advice says:

UMost women in their 40s should not routinely get mammograms.

UWomen 50 to 74 should get a mammogram every other year until they turn 75, after which the risks and benefits are undetermined. (The task force’s previous guidelines had no upper limit and called for exams every year or two.)

UThe value of breast exams by doctors is undetermined. And breast self-exams are of no value.

Medical groups such as the cancer society have been backing off promoting breast self-exams in recent years because of scant evidence of their effectiveness. Decades ago, the practice was so heavily promoted that organizations distributed cards that could be hung in the shower demonstrating the circular motion women should use to feel for lumps in their breasts.

The guidelines and research supporting them were released Monday and are being published in today’s issue of the Annals of Internal Medicine.