Ob-Gyn Physicians Support Mammograms Starting at Age 40

The American College of Obstetricians and Gynecologists this week recommended annual mammography screenings for women starting at age 40, an expansion of its prior guidance that patient advocates hailed as a move that would help bring clarity to a cloudy issue.

In doing so, the college added its voice to a controversy over the optimal timing and frequency for routine breast cancer screenings that intensified nearly 2 years ago when a federal panel recommended longer timeframes starting at a later age.

The conflicting advice comes amid rising concern that many women whose mammograms are covered under their health insurance plans are not following any of the screening guidelines.

The college previously recommended mammograms every 1 to 2 years starting at age 40 and annually beginning at age 50.

Jennifer Griffin, MD, MPH, who co-authored the guidelines, cited 3 factors prompting the change to annual screenings starting at age 40: the incidence of breast cancer, the “sojourn time” between the detection of a small mass and its growth to a symptomatic tumor, and the potential to reduce deaths with early detection.

In fact, women ages 40 to 49 demonstrate the shortest average sojourn time (2-2.4 years), while woman ages 70 to 74 have the longest average (4-4.1 years), the college said in a press release.

“If women in their 40s have annual mammograms, there is a better chance of detecting and treating the cancer before it has time to spread than if they wait two years between mammograms," Griffin said in the release.

Similarly, the Susan G. Komen for the Cure advocacy group applauded the college’s new guideline, saying in a statement the recommendation would help clear up confusion that grew after the US Preventive Services Task Force (USPSTF) weighed in on the subject in 2009.

The USPSTF, a federally appointed panel of experts, recommended that the decision to start regular mammography screenings should be an individual one for women under age 50. The panel supported biennial screenings for women aged 50 to 74.

The Komen group said the USPSTF was seeking to take into account the potential for overtreatment and the anxiety that results from false positives, but maintained women are better served by more screening vigilance.

The American Cancer Society recommends healthy women undergo annual mammography screenings beginning at age 40.

Practice bulletin no. 122: breast cancer screening. Obstet Gynecol. 2011;118(2 Pt 1) :372-382.