Women urged to wait until 45 for breast cancer screenings

In a controversial shift, a leading US medical association today urged women to wait until the age of 45 before getting an annual mammogram to screen for breast cancer.
The American Cancer Society previously recommended women be screened each year from 40, but has changed its advice because evidence failed to show enough lives are being saved.
And while younger women are being advised to start later, women over 55 are now urged to switch to getting mammograms every two years, instead of annually.
"Since the last American Cancer Society (ACS) breast cancer screening update for average-risk women was published in 2003, new evidence has accumulated from long-term follow-up of randomized controlled trials and observational studies," said the guidelines, published in the Journal of the American Medical Association (JAMA).

Women should still have the opportunity to begin annual screenings at 40 if they choose, the guidelines noted.
Breast cancer is the most common form of cancer in women worldwide. It is also the deadliest form of the disease in women, after lung cancer.

More than 40,000 women in the United States will die of breast cancer this year, according to background information in the article.
Early detection can help improve survival, but screening all women beginning at age 40 can also lead to problems, such as false positives, biopsies, surgeries to remove masses that may not have been dangerous, and potential surgical complications.

Evidence from clinical trials has shown little benefit from mammograms when it comes to saving lives among younger women, said an accompanying editorial by Nancy Keating of Harvard Medical School and Lydia Pace of Brigham and Women's Hospital.
They wrote that regular mammography might prevent breast cancer deaths in about five of every 10,000 women in their 40s or 10 of every 10,000 women in their 50s.
"Thus, about 85 percent of women in their 40s and 50s who die of breast cancer would have died regardless of mammography screening," they wrote.
Offering more sophisticated screening tests, including genomic risk factors, would be better for younger women than expanded screening mammography, they argued.

The new guidelines also no longer recommend breast exams, in which clinicians manually feel patients' breasts for lumps, for women of any age who do not have a family history of breast cancer.