Doctors, Patients Divided Over Best Age To Begin Breast Cancer Screening, Survey Finds

Most physicians say they will comply with the U.S. Preventive Services Task Force's latest guidelines on breast cancer screening, while most female patients plan to ignore the recommendations, according to an editorial in the Annals of Internal Medicine, the New York Times reports. The guidelines, released in November 2009, call for biennial mammograms for women ages 50 through 74 and advise against routine annual mammograms for most women in their 40s.

The journal, which published the guidelines in November 2009, sought comments on its Web site from patients, doctors and other health care workers. A majority of the 345 doctors who responded said they would no longer offer routine mammograms to women in their 40s and that they would most likely counsel women ages 50 through 74 to receive a mammogram once every two years. Of the 241 patients who responded, a majority said they did not believe in foregoing mammograms in their 40s -- even if a doctor recommended otherwise -- and that they were not likely to switch to biennial screenings.

Christine Laine, editor of the journal, said that the dichotomy between patient and doctor responses "makes me think there will be some pretty interesting discussions between health care providers and women around the issue of breast cancer screening, but I think that's really at the heart of what the recommendations were saying should happen -- so that's a good thing."

After USPSTF unveiled the guidelines, some critics said that insurers might change their coverage policies for mammograms. So far, that does not seem to be the case, Susan Pisano, a spokesperson for America's Health Insurance Plans, said. "My understanding is that when a physician orders a mammogram, there's coverage," she said.

Pisano and Laine both noted that the guidelines leave room for individual breast cancer screening decisions. "Now that the dust has settled, there's a better understanding of what the task force was saying," Laine said, adding that the guidelines do not alter recommendations for women at higher risk for breast cancer. She said, "It was not saying, 'Don't ever get a mammogram if you're 40.' It was saying that in the younger age groups the balance of risks and benefits is not clear in one direction" (Rabin, New York Times, 2/16).


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