Less than one week after the release of new breast cancer screening guidelines recommending annual MRIs for women at high risk for breast cancer, the American College of Physicians issued new guidelines today “challenging the widely accepted recommendation that women routinely undergo mammograms in their 40s, saying the risks of the breast exams may outweigh the benefits for many women,” reports the Washington Post.

Yearly mammograms starting at age 40 are recommended by the American Cancer Society. The ACP is instead urging women to discuss the risks/benefits with their doctors.

“We agree that mammography can save lives,” said Douglas K. Owens of Stanford University, who chaired the committee that wrote the guidelines. “But there are also potential harms. We don’t think the evidence supports a blanket recommendation.”

From the Washington Post:

The group based its recommendations on a comprehensive review of mammography research that concluded that the benefits are less clear for women in their 40s than for those 50 and older, and that screening carries significant risks, including exposure to radiation and unnecessary biopsies, surgery and chemotherapy.

The new guidelines elicited mixed reactions from breast cancer doctors, researchers and patient advocates. Some condemned them, saying mammograms help catch tumors at their earliest, most treatable stage, reducing the death toll from the common malignancy. Breast cancer tends to be especially deadly when it strikes women in their 40s, they noted. […]

But others said the recommendations represent a more nuanced approach that better reflects what is known about the benefits and drawbacks of mammography.

Continue reading the WaPo story here.

Here’s the ACP press release summarizing the recommendations. The new clinical guidelines, a background article, an editorial, and a patient summary appear in today’s issue of Annals of Internal Medicine, published by ACP.

Plus: The New York Times today looks at the questions raised by the newly released American Cancer Society guidelines recommending annual MRI scans starting at age 30 for women at high risk.

The scans can find cancer missed by other methods, but there’s also a great deal of concern that the recommendations are not realistic from a public policy perspective, in part because of insurance costs and an inconsistency of quality across MRI centers:

Many women have no idea which risk category they belong to, researchers note. Several studies have found that women tend to overestimate their chances of breast cancer, and the risk models used by clinicians can produce widely varying results.

And it is far from certain that there are enough qualified facilities to handle an influx of high-risk women who may now seek regular M.R.I. screenings.

“From an individual woman’s point of view, I think these guidelines are useless,” said Barbara Brenner, executive director of Breast Cancer Action, an advocacy group in San Francisco. “We don’t have a medical system that can do this. It’s just not the real world.”

Because M.R.I.’s are more sensitive than mammograms or ultrasound, they are more likely to reveal suspicious anomalies that turn out to be benign. Every false positive generates expense, anxiety and treatment that may not be necessary.

Continue reading here.

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