Health panel issues new advise for mammograms

A federal health panel has proposed new guidelines for screening mammograms, urging all women to start them at age 40, instead of 50.

The draft recommendations from the United States Preventive Services Task Force are not final, but are likely to be approved after a period of public comment. The task force, appointed by the Department of Health and Human Services, wields enormous influence, and its recommendations are closely followed by the nation’s primary care physicians.

Here are answers to common questions about mammography, as well as the new recommendations.

Who should be getting regular mammograms?

If the new recommendations are approved, women will be advised to start getting screening mammograms at age 40. Current guidelines recommend starting by 50 and advise women in their 40s to discuss the risks and benefits with their doctor. As a result, many women in their 40s already get screening mammograms, but the new recommendations would formalize that advice and increase the likelihood of insurance companies paying for the screening test.

The recommendations are to help women “live longer and healthier lives,” and “we’re urgently calling for more research to help us reduce health disparities among women who are screened and treated, especially for Black women who get more aggressive cancers and die more often from breast cancer,” said John Wong, an internist and professor of medicine at Tufts University School of Medicine, who is on the task force.

Screening mammography is not recommended for most women who have had bilateral mastectomies, experts said. If a symptom occurs, speak with your doctor about the best next steps, including alterative imaging.

How often should a woman get a mammogram?

The frequency of mammogram screening is a subject of debate. The new recommendations suggest women get screened every other year. Among other things, biennial screening reduces the risks of false positives – in which a woman is called back for additional testing because of an abnormality on the test. Mammography callbacks can be extremely stressful, but most of the time the finding is not cancer.

The task force said it made its recommendations after analyzing the potentially lifesaving benefits of early breast cancer detection vs. potential harms, including false positives that may take a psychological toll and lead to unnecessary follow-up tests and procedures, as well as the added – yet minimal – radiation exposure.

The American Cancer Society and other organizations, however, advise annual mammograms. One concern is that skipping a year between screenings would give undetected cancers more time to grow.

“A two-year interval can allow a more aggressive breast cancer to grow significantly and reduce the chance of the patient being cured or increase the chance that she needs additional treatment,” said Maxine Jochelson, chief of the breast imaging service at Memorial Sloan Kettering Cancer Center.

Should older women get mammography screening?

The task force advises biennial mammography screening until age 74. The task force noted in its draft that there was not enough evidence to assess the risks vs. benefits of screening mammography in women older than 74.

What if I have dense breasts?

The new recommendations do not provide specific guidance on the use of alternative or additional forms of imaging such as ultrasound or magnetic resonance imaging (MRI), which may be needed when patients have dense breasts.

In March, the Food and Drug Administration updated its mammography regulations to require facilities to tell patients about the density of their breasts and suggest that those with dense breasts speak to their doctor about their risks.

The task force stated in its draft that current evidence was “insufficient to assess the balance of benefits and harms of supplemental screening for breast cancer” in women with dense breasts.

Wong said more research is needed.

“Women with dense breasts deserve to have that knowledge,” he said. “It would be tremendously helpful for us as health-care professionals to have that information so that we can make a recommendation on whether and, if so, how to best supplement with additional screening.”

Should members of the trans and nonbinary community get mammograms?

The guidance applies to anyone between the ages of 40 and 74 who was assigned female at birth. This includes nonbinary or transgender people who have had most – but not all – of their breast tissue removed and still need routine screening, experts said.

In such cases, some breast tissue is left behind, Jochelson said. So people who were assigned female at birth “still need to be screened depending on their risk, their family history and any mutations in the same fashion as anybody else who has breasts,” she said.

How long does a mammogram take?

The procedure takes about 30 minutes. Each breast will be compressed for about 20 to 30 seconds.

Do mammograms hurt?

Women say that having their breast compressed in the scanner is uncomfortable, but compression is needed to spread and flatten the breast to get the best view of the tissue. For women who have not started menopause, scheduling the procedure for the week after their menstrual period is advised because breasts usually are less tender then.

What is the difference between a screening and diagnostic mammogram?

A screening mammogram is used to find breast cancer early, before it forms a lump. A diagnostic mammogram is used if breast cancer is suspected after a lump or other symptom of the disease is identified. Diagnostic mammograms are also used to follow up when an abnormality is detected on a screening mammogram.