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Breast Cancer Screening Should Begin at Age 50, Panel Finds

BY Lea Winerman  November 16, 2009 at 6:13 PM EDT

Race for the cure participants; file photo

In 2002, the same panel — the United States Preventive Services Task Force — had, with different members, recommended that women receive mammograms every one to two years beginning at age 40.

The panel on Monday also recommended that most women stop getting regular mammograms after age 74, and that doctors should no longer teach women to do breast self-examinations.

Members of the panel, which is part of the U.S. Department of Health and Human Services, said that screening for breast cancer too early and too often can lead to false alarms, unnecessary biopsies and unnecessary anxiety for women.

The study is the latest chapter in an ongoing controversy over early screening for breast cancer and other cancers, such as prostate cancer. Such screening saves lives, but in addition to sometimes showing false positives, can also reveal cancers that would have grown so slowly they might not ever need to have been treated.

“We’re not saying that women shouldn’t get screened; screening does save lives,” Diana B. Pettiti, vice chairman of the task force, told the Washington Post. “But [...] there are important and serious negatives or harms that need to be considered carefully.”

Dr. Pettiti told the New York Times that although the new guidelines may come a shock to many women “we have to say what we see based on the science and the data.”

The new recommendations are likely to touch off another round in the ongoing debate over regular cancer screening.

Some patient advocacy groups praised the new recommendations.

“This is our opportunity to look beyond emotions,” Fran Visco, president of the National Breast Cancer Coalition, told the New York Times. “These are the people we should be listening to when it comes to public health messages.”

But other groups condemned the change and the revisions are expected to be hotly debated. The American Cancer Society said it plans to continue to recommend annual mammograms for all women over 40.

“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,” Dr. Len Lichtenfeld, the American Cancer Society’s deputy chief medical officer, told NPR

About 39 million women undergo mammograms each year in the U.S., at a cost of more than $5 billion per year, the Washington Post reported.

Dr. Carol Lee, chair of the American College of Radiology Breast Imaging Commission, told Reuters in a statement the recommendations “ignore the valid scientific data and place a great many women at risk of dying unnecessarily.”

Lee and Lichtenfeld said they fear insurers will use them to pare back health costs. In media interviews, Petitti said that cost was not a factor in their decision-making.

And Donald Berry, a statistician who worked with the task force, told the New York Times “the money was buying something of net negative value. This decision is a no-brainer. The economy benefits, but women are the major beneficiaries.”

The researchers analyzed data from U.S. and European studies, including a Swedish study of 70,000 women, a British study of 160,000 and a U.S. study of 600,000 women. They found that early screening prevented one cancer death per every 1,904 women who were screened between ages 40 and 49, but prevented one death per 337 women screened between ages 60 and 69.

The new guidelines do not apply to women in high-risk groups, such as those who have had close relatives with breast cancer or those with a gene mutation that increases the risk of cancer.