Thursday, January 7, 2010

Screening Mammogram Recommendations

You may recall, in November 2009, the US Preventive Services Task Force released new recommendations on screening mammography.  Here is a summary:

  • The USPSTF recommends biennial screening mammography for women aged 50 to 74 years.
  • The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms.

For a complete discussion which I can not improve upon, check out  Dr. Margaret Polaneczky’s (aka TBTAM) post:  The New Mammogram Guidelines - What You Need to Know.

Now comes, recommendations from the American College of Radiology (ACR) and the Society of Breast Imaging (SBI).  Their guidelines for screening mammography are published in the January issue of the Journal of the American College of Radiology.  Their recommendations do not agree with the US Preventive Services Task Force.

The ACR and SBI recommendations:

  • Screening mammography should begin at age 40 for women with average-risk of breast cancer.
  • Women at higher-risk should begin by age 30, but no sooner than 25.
  • Women who have at least a 20% lifetime risk of breast cancer, on the basis of family history, also should begin annual breast MRI by age 30, in addition to annual mammography.
  • Breast ultrasound may also be recommended in addition to mammography for high-risk women and those with dense breast tissue that is often difficult to assess by conventional mammography

Women and their doctors can use assessment tools to calculate  individual risk for breast cancer.  The most commonly used risk assessment tool is the Gail Model which can give your individual risk of being diagnosed with breast cancer in the next 5 years.

Breast cancer causes about 4,500 deaths annually in women ages 40-49, and is one of the leading causes of death in women in this age group.

3 comments:

StorytellERdoc said...

Great post! Since we all have women we love in our lives, we only want what's best for them. Do you have any personal thoughts on these guidelines? I feel we went from one very strict extreme to more middle ground (the MRI recommendation surprised me, though).

Well done and thanks. Always enjoy your post.

rlbates said...

I still tend to gently push women into at least a base line mammogram by age 40. If no significant risk factors, then I lean towards every two years between 40-50. If significant risk factors, I push towards yearly and younger.

artdoctor said...

Canadian recommendations are same/similar to the ACR and SBI recommendations. I know women who have been diagnosed at my age, and women at age 40/+, so really, it's not too early.