Tuesday, November 17, 2009
Guidelines for Mammograms Changed
For years women have been advised to have an annual mammogram starting at age 40. The advice and insurance coverage for mammograms has been so effective that nearly 2/3 of women over age 40 had mammograms. Scratch that advice. The new guidelines, published in the Annals of Internal Medicine will spark a wave of controversy. Women are now advised NOT to have screening mammograms until age 50 and then to space them every other year. The United States Preventive Services Task Force, an independent panel of experts, says the new guidelines were based on new data and analysis and were aimed at reducing the harm of overscreening.
Why the switch? The report says the risk/benefit of mammogram just doesn't pan out for women age 40-49. The task force said that once cancer death is prevented for every 1,904 women who are screened for 10 years in the 40-49 age range. As a woman ages, her risk of cancer increases so one death is prevented for every 377 women screened at age 60-69.
Mammograms often detect abnormalities that are not serious. These false positives cause women to undergo more testing and biopsies that can cause harm. The Task Force recommends the way to get the most benefit and the least harm is to start screening at age 50 and have approximately 10 mammograms in a lifetime.
The new advice will undoubtedly change the insurance and Medicare coverage for mammograms. Already the group that "grades" health plans on quality, the NCQA, is changing the measure for mammograms to women over age 50, every two years.
We can expect an outcry from women who had an early mammogram and it "saved my life". People will say it is part of "Obamacare" and meant to save billions of dollars ( BTW, it will save $billions) but they would be wrong as the USPSTF is probably the most impartial scientific group around.
The new guidelines do not apply to women with genetic markers or family history of early breast cancer. Let the debates begin.
Posted by Toni Brayer, MD at 6:58 AM