Mammograms Decline in 40-49 year Old Age Group

Since the US Preventive Service Task Force published revised guidelines recommending individualized screening schedules rather than routine annual mammograms for low to average risk women in their 40’s, the number of mammograms being done in this age group has declined.

In the year after the guidelines were published, nearly 54,000 fewer mammograms were performed on women ages 40 to 49. That represented a 5.72 percent decrease from the previous period. The authors said that the modest reductions probably reflected some public resistance to the new recommendations, in part because of conflicting guidelines from other groups that urge more frequent routine screenings.

I’m not surprised.

The study reflects what I’ve been seeing in my own practice – women in their 40’s asking “Do I really need this test?”  and “Can I wait till I am 50?”. In most cases, after confirming that a patient is not an increased risk of having concerning symptoms or exam findings, we end up compromising on an every other year schedule. This seems to be something both they and I can feel comfortable with in light of the newness of the recommendations and the current medical legal climate in the United States.  The few who have chosen to wait till 50 tend to be those who come from Europe (where mammgrams are done later than in the US) and those with prior experience, either personal or familial, of harms from mammograms.

6 Responses to Mammograms Decline in 40-49 year Old Age Group

  1. Peggy,
    I am not so comfortable with this as you. I think screening decisions should be informed. But I worry deeply that doctors don’t understand the limitations of the USPSTF’s archaic analysis. Many primary care physicians’ recommendations are biased by what they read from a very vocal group of journalists and epidemiologists with anti-screening bias, as are patients’ preferences. Besides a lack of objective information on this from either “side,” many women choose not to be screened now because they can’t afford or prefer not to spend what money they do have on co-pays for the procedure and biopsies if needed.

    • Elaine-

      I like to think my patients are making informed decisions based not on journalist opinion but on the date that drove the guidelines and on extensive discussion as well as consideration of their own personal values and concerns around breast cancer. Copays and cost have not been at issue in my practice.

      We desperately need tools that support objective, shared decision making around mammography. Working on that very thing as we speak.


  2. Peggy – Is every other year considered by “the medical establishment” to be acceptable for a 50 year old without known risk factors other than not ever having had children? I see my ob/gyn for my annual well woman exam next week and plan to discuss this as well as getting back on the pill (a low dose version) for birth control and peri-menopause

    I just turned 50. I’m not overweight, exercise 3 to 4 times a week, had several mammograms in my 40’s and two call backs – both times the conclusion was cysts after ultrasound and additional views.

    The only family cancer history is that my mother’s sister’s was diagnosed with ovarian cancer in her late 50’s or later and died from it.

  3. I find the USPSTF recommendations ridiculous at best and dangerous at worst. The thing that bothers me the most is that they recommend AGAINST breast self-examinations. I can’t tell you how many lumps I’ve removed from women who have found their own breast cancers doing self exams. Who knows your breasts better than you? Who is most likely to find something “new” or “different” about them?

    I haven’t changed my practice one bit based on these “recommendations”. Fortunately I haven’t had a single woman ask me if her mammogram is really necessary. If one does, I will simply tell her “Yes. Yes it is.”

  4. The last post makes clear why women need to be careful and find a doctor you can work with…I have declined mammograms, an informed decision. It is impossible for most women to make informed decisions because the information received is incomplete and biased in favor of screening. The Nordic Cochrane Institute, an independent medical research group, published their first report a decade ago expressing concern about over-diagnosis and uncertainty of benefit. Breast Screen here in Australia chose to ignore the report, conceal over-treatment and inflate the benefits. The NCI in their latest review no longer recommend screening at all.

    Give me evidence based medicine every time. Clinical breast exams and self exams haven’t been recommended here for quite a few years. I also found lectures and articles by Prof Baum, UK breast cancer surgeon, to be helpful and the excellent summary by the NCI, “The risks and benefits of mammograms” at their website.
    I’ve never understood how the govt and doctors get away with making up screening stories, rather than provide the risks and actual benefits and allow us to decide…as they do in prostate screening. Our program continues to ignore the widespread concerns about this screening and keeps pushing to achieve their screening target..their latest ads provide no real information and simply urge women to “do it for the people you love”…it’s an insulting and unacceptable way to treat women.
    I think women will have to retrain doctors to see women as competent adults, not idiots or children…. of course, this doesn’t apply to all doctors…some individual doctors are just as concerned at the double standard that so clearly exists and the complete lack of proper ethical standards and for informed consent.

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