US federal task force recommends against current advice for breast checks to start at 40

Washington: A key US advisory panel has recommended against routine mammograms for women in their 40s, suggesting that these women decide themselves when to start after weighing the risks and benefits.  It also suggested that women aged 50 to 74 should be screened every other year.

According to the influential US Preventive Services Task Force, the potential harm to women having annual exams beginning at age 40 outweighs the benefits.  

The guidelines which also recommended against teaching women to do regular self-exams of their breasts and concludes that there is insufficient evidence to continue routine mammograms beyond age 74, immediately triggered intense debate.

Published yesterday in the Annals of Internal Medicine, they pit the task force against the Cancer Society, which said doctors should advise women to get routine annual screening starting at age 40.

But disease epidemiologist Diana Petitti, vice chairman of the panel, clarified the panel's stand.

"This is not a blanket recommendation not to worry until age 50," she said.  "Its recommendation to have a discussion with your physician to better understand the trade-offs between starting exams now and starting later."

Several patient advocacy groups and many breast cancer experts praised the shift, saying it represents a growing recognition that more testing, exams and treatment are not always beneficial and infact can harm patients.

Mammograms produce false-positive results in about 10 per cent of cases, causing anxiety and often prompting women to undergo unnecessary follow-up tests, sometimes disfiguring biopsies, and unneeded treatment, including surgery, radiation and chemotherapy.

 But the American Cancer Society, the American College of Radiology and other experts condemned the change, saying the benefits of routine mammography have been clearly demonstrated and play a key role in reducing the number of mastectomies and the death toll from one of the most common cancers.

"Tens of thousands of lives are being saved by mammography screening, and these idiots want to do away with it," said radiology Professor Daniel Kopans of Harvard Medical School.  "It's crazy - unethical, really."

According to doctors from National Cancer Centre Singapore, the issue of whether to screen women in their 40s has always been controversial, as studies have never been big enough to prove the benefits of screening for this age group.

They noted that Singapore's cancer incidence rises sharply at age 40, and a significant number of cancers detected under the Breast Screen Singapore programme are in the 40-49 year group. "Thus we cannot withdraw our support for screening in this age group," they said.

 Government guidelines in Singapore recommend that women 40 to 49 years of age go for annual mammograms while those 50 and above should do so every two years.