For the first time in 20 years, a government panel is telling women in their 40s to stop getting routine mammograms and recommending that a host of other breast cancer screenings slow down.
The United States Preventive Service Task Force announced Monday that it recommends against annual mammograms for women age 40 to 49 because, they say, the benefits of testing do not outweigh the "harms" and risks.
USPSTF still recommends doctors start screening all women over age 50, but with a mammogram once every two years instead of annually.
The task force also recommends against teaching breast self-exams for all women and said evidence was insufficient to recommend mammograms for women older than 74.
The recommendations were only for women considered to be at normal risk for breast cancer. Women who are at a known high risk -- for instance, women who tested positive for the BRCA-1 and BRCA-2 genes -- would not fall under the guidelines.
Family doctors often abide by the task force's recommendations in their practices, and insurance companies routinely turn to USPSTF -- a panel of independent medical experts -- to guide coverage plans.
But the recommendations announced today, which contradict the American Cancer Society, have already pitted doctors, women, insurers and radiology groups in a fierce debate about who should get a mammogram and when.
"These new recommendations are long overdue. Most countries do not support mammography screening under 50 and do it every other year after 50 in their government-sponsored screening programs," said Dr. Susan Love, founder of the Dr. Susan Love Research Foundation.
"I hope that the insurers will change reimbursement, because it is probably the only way that women will be spared the extra radiation exposure of too many mammograms," Love said. "Since our system pays the radiologist, hospital or mammography center and biopsying surgeon by the more they do, there is no incentive for this to come from the medical profession."
But others feel quite differently.
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"Their justification: these new guidelines capture 81 percent of mammography's benefits, save a lot of resources, with only a 3 percent drop in survivorship from the most common cancer to affect women," said Dr. Marisa Weiss, president and founder of BreastCancer.org. "But what really is the cost? And who is paying that price? It could be you, your mom, daughter, sister, aunt or grandmother, or all of us."
Anecdotally, most people in the United States can think of a woman they know who caught breast cancer through a routine mammogram long before she turned 50. Many patient advocates wonder if money fueled the decision.
"I think a lot of it is about money, and we know that we need to make health care cuts, but this isn't the way we need to make money," said Hillary Rutter, director of the Adelphi New York Statewide Breast Cancer Hotline and Support Program.
However, Dr. Diana Petitti, vice chair of USPSTF, said the task force never looked at costs in their research or their recommendations.
"The task force doesn't deal with insurance and coverage," Petitti said. "Cost was not a part of what the task force looked at."