Mammography Guideline Changes May Lead to Missed Cancers

In 2009, controversial new guidelines were released that recommended routine biennial screening with mammography only for women 50 to 74 years old

Researchers recently assessed the impact of the 2009 revised guidelines for screening mammography issued by the US Preventive Services Task Force (USPSTF). Evidence showed that the new recommendations may result in missed cancers, according to a study presented at the annual meeting of the Radiological Society of North America.

Traditionally, routine screening mammography has been recommended by both the USPSTF and the American Cancer Society for all women over the age of 40. However, in 2009, controversial new guidelines were issued by the USPSTF recommending routine screening with mammography every 2 years for women 50 to 74 years old.

“Recommendations on screening mammography are extremely important public policy and we wanted to contribute to that dialogue,” said Elizabeth Arleo, MD, assistant professor of radiology at New York-Presbyterian Hospital, Weill Cornell Medical College, in New York City. “We get questions all day long from patients and referring physicians on the appropriateness of screening mammography. The inconsistent information is very confusing for everyone.”

For the study, Arleo and colleagues evaluated data on screening mammography at New York-Presbyterian Hospital, Weill Cornell Medical College, for women between the ages of 40 and 49 for the years 2007 through 2010. Over the 4 years, 43,351 screening exams were performed, which resulted in the detection of 205 breast cancers.

Study results showed:

·  Of the 43,351 screenings in the study, 33.5% were of women between the ages of 40 and 49

·  Of the 205 breast cancers detected, 39 (19%) were in women between the ages of 40 and 49

·  Of those cancers, more than 50% (21 of 39) were invasive

·  Of the women between the ages of 40 and 49 diagnosed with cancer, only 3 had a first-degree relative with premenopausal cancer

“Nearly 20% of cancers detected with screening mammography were found among women in their 40s,” Arleo said. “It seems unacceptable to potentially miss nearly 20% of the breast cancers we are identifying. This, in our view, would represent a substantial degree of underdiagnosis. Our data favor the American Cancer Society recommendations of annual mammograms starting at age 40.”

Source: RSNA.