(Bloomberg)–The American Cancer Society changed its guidelines for early breast cancer detection, recommending that women wait until age 45 instead of 40 to start annual mammograms, then slow the pace at 55 to screenings every other year.
The recommendation is designed to reduce erroneous results that require additional imaging and biopsies that find no cancer, creating unnecessary alarm and adding the risks that come with surgery.
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The decision more closely aligns the influential U.S. health organization with other recent guidelines that are profoundly changing decades-old medical conventions and the care for millions of women.
The guidelines, published Tuesday in the Journal of the American Medical Association, apply to women with an average risk of breast cancer and are flexible. Women should begin talking with their doctors about mammography when they reach age 40, and should continue to have access to annual exams at that age if they and their doctors feel it's needed, the cancer group said.
The change stems from new information on the development and progression of cancer and how screening affects the process at different ages, said Kevin Oeffinger, leader of the American Cancer Society panel that updated the guidelines and director of the Cancer Survivorship Center at Memorial Sloan-Kettering Cancer Center.
The recommendations are designed to balance the benefits of early detection with the risks of overdiagnosis and unnecessary care, while taking into account women's individual values, he said.
"After looking at literally hundreds of studies, we were convinced that mammography remains an essential tool, and it is still the single best tool for preventing a premature death in a woman with breast cancer," Oeffinger said. "But most women will not have breast cancer. You can think of mammography as an insurance plan–something you hope you won't need but you're glad to have if you do."
False positives
The 11-member panel that reworked the ACS guidelines for the past two years was swayed by research that found women 40 to 44 were less likely to have breast cancer and comparatively more likely to have a false-positive result requiring additional imaging or a needle biopsy, the researchers said.
Mammography, performed with equipment from companies including Hologic Inc., General Electric Co. and Siemens AG, is designed to help detect breast cancer in the early stages when it is most likely to be cured. More than 230,000 women are diagnosed a year, making it the most common cancer in women. Even with aggressive screening and improved treatments, it is the second-most-deadly tumor for females after lung cancer, killing more than 40,000 women each year.
Shares of Hologic, the biggest manufacturer of mammography equipment in the U.S., fell 2 percent to $37.77 at 11:50 a.m. in New York after the new guidelines were released.
The new publication is the first update of the guidelines since 2003. The recommendations also include:
* Continuing exams for women expected to live at least 10 years * Allowing an earlier start at age 40 and annual exams as desired * Eliminating breast exams in doctors' offices
The advice moves the American Cancer Society closer to the guidance offered by the U.S. Preventive Service Task Force, a government panel that triggered outrage in 2009 by saying universal, annual screening starting at age 40 was excessive and could be harmful for many women.
Lawmakers worried the decision could lead to fewer insurance reimbursements for screenings and wrote language into the Patient Protection and Affordable Care Act telling health insurers to ignore the recommendation.
But the task force reiterated the recommendations in draft guidelines it released in April.
The American Cancer Society's changes were welcomed by the U.S. panel, which said it would consider the new recommendations as it finalizes its own.
The USPSTF, which currently urges biennial screening for women 50 to 74, noted the similarities between the two groups, including the finding that the benefits of mammography increase with age.
'Debate over'
Even groups that believe annual exams are essential found reason to embrace the new ACS recommendations.
"This report reaffirms that mammography screening leads to a significant decrease in breast cancer mortality," said Debra Monticciolo, chair of the American College of Radiology's Breast Imaging Commission. "I'm hoping that what women will get from this is the clear benefit of mammography. That part of the debate is over."
A separate study in JAMA Oncology found younger women who were diagnosed with breast cancer tended to have larger, more advanced tumors if they underwent a mammogram every other year rather than annually.
There was no significant difference in the tumor makeup for older women who had gone through menopause and weren't taking hormone replacement therapy, making biennial exams less problematic and more acceptable for them.
The changes do introduce more complexity for patients and their doctors, wrote Nancy Keating, from Harvard Medical School's department of health-care policy, and Lydia Pace, from Brigham and Women's Hospital's division of women's health, in an editorial accompanying the new guidelines.
Women and their doctors may also find it difficult to transition from no screening to annual screening to biennial screening, they said.
Ultimately new technology and a more personalized approach will best help women understand and manage their breast cancer risk, they said.
If women at the highest risk for aggressive breast cancer can be identified, they would be most likely to benefit and less likely to be harmed by earlier and more aggressive screening, Keating and Pace said.
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