American Cancer Society says start mammograms at 45, not 40

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CHICAGO -- In the ever-changing and confusing advice about when to get screened for breast cancer, the American Cancer Society is now joining federal regulators in telling women to wait to get their mammogram.

For years women were told – get your mammogram at age 40. The screening will detect early cancer. When doctors find cancer early, they can treat it less aggressively, and that means better outcomes for women. Survival without side effects.

"The patient’s discussion should begin with her physician starting around 40, and the most lives are saved if we screen annually around 40," said Dr. Sarah Friedewald, Northwestern Medicine radiologist.

But the American Cancer Society now says don’t get a mammogram until age 45 -- a five-year push. Their reason, according to experts: earlier screenings do not improve survival rates.

"The issue that they’re bringing up that hasn’t been discussed previously by ACS are the false positives or the harms associated with breast cancer screening, so they’re trying to point out that the harms are out there, that it’s important to consider those in relation to annual screening," Friedewald said.

The new ACS guidelines fall more closely in line with the US Preventive Services Task Force, which says women can wait until 50 for their first mammogram. So what do doctors who screen women for breast cancer advise in regard to the new recommendations?

"Most patients are still listening to their referring physician, and that conversation is very important," Friedewald said.

After 45 the ACS says women should have mammograms every year until 55 then every other year. Federal regulators say every other year is fine beginning at 50. And in a surprise statement, now a panel of health experts say clinical breast exams by doctors during office visits are unnecessary at any age.

"There’s really no evidence to support that the clinical breast exam is actually saving lives, and it seems a little counterintuitive, but we do rely on the evidence," Friedewald said.

"I think it’s important that patients are aware of their breasts and understand changes, but I think the ritualistic self breast exam really hasn’t been shown to be beneficial, and, again in light of the false positives or the harms associated with screening, it leads to a lot of unnecessary testing down the road," Friedewald said.

With the new recommendations, there is a question about insurance. Coverage may change or be cut off for women in their 40’s since medical experts are not recommending breast cancer screening until 45-50.

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