American Cancer Society Reverses Course


The American Cancer Society now says women should start mammograms later in life and get fewer of them, a stance that puts the trusted group closer to an influential government task force’s advice.

In new guidelines out Tuesday, the cancer society recommends that most women should begin annual screenings at age 45 instead of 40, and switch to every other year at 55. The task force advises screening every other year starting at age 50.

The advice is for women at average risk of this type of cancer. Doctors generally recommend more intensive screening for higher-risk women.

“It’s not that mammograms are ineffective in younger women,” but at age 40, this type of cancer is uncommon and false alarms are more likely, said Dr. Richard Wender, the cancer society’s cancer control chief.

Concern about false alarms contributed to the cancer society’s new guidance. These lead to worry and more testing — they mean an initial result was suspicious but that cancer was ruled out by additional scans and sometimes biopsies.

The latest guidelines acknowledge that some younger women are willing to accept that, and that for them starting annual exams at age 40 is fine, as long as they know the risks.

The guidelines were developed by experts who reviewed dozens of studies including research published since 1997 — the year the medical group recommended yearly mammograms starting at age 40, and since 2003.

The guidelines were published Tuesday in the Journal of the American Medical Association.

The U.S. Preventive Services Task Force, whose guidelines have historically influenced Medicare coverage, made waves in 2009 when it recommended mammograms every other year starting at age 50, to age 74. In draft recommendations released earlier this year, the group said mammograms for women in their 40s should be an individual decision based on preferences and health history, and that more research is needed to determine potential benefits or harms for scans for women aged 75 and older.

Most health plans are required to cover screening mammograms free of charge as part of preventive care mandated by the Affordable Care Act, and many insurers cover the screenings starting at age 40.

Several doctor groups still recommend mammograms starting at age 40, but the American Cancer Society’s guidelines are the most widely followed, said Dr. Kenneth Lin, a family medicine physician at Georgetown University School of Medicine.

Lin said that he supports the new guidance but that it will make his job more challenging at first, trying to explain to patients the changes and differences with other groups.