Previously, the American Cancer Society recommended that women get mammograms every year starting at age 40. But on Tuesday, new American Cancer Society mammogram recommendations were released stating that mammograms are only necessary once a year from ages 45 to 54 and then once every other year after that for those with an average risk of breast cancer. Furthermore, the group is no longer recommending clinical breast exams (in which doctors or nurses feel for lumps) for those without a heightened risk for breast cancer.
The revised guidelines, published in the Journal of the American Medical Association, are based on increasing evidence that mammograms have a high rate of false-positive results, which lead to unnecessary tests like biopsies, which can cause pain and carry risks. However, the paper also states that people should "have the opportunity" to undergo screening as often as previous guidelines suggested. In addition, the new recommendations don't apply to those with breast cancer in their families or those who have genetic or medical risks.
But some are wondering why the American Cancer Society would miss the chance to prevent even one death at the hands of breast cancer. One commenter said, "I'd be dead with these guidelines," presumably meaning her cancer was caught during a mammogram at an age or frequency not recommended by the new recommendations. Another commenter agreed: "I would also be dead with these recommendations." Yet another wondered, "What are the implications of this for insurance coverage? It took long enough for mammograms to be recognized as necessary medical attention for women, rather than 'preventive medicine.'"
Medicare currently covers yearly mammograms for women ages 40 and over under the Affordable Care Act, and Medicaid coverage is different for each state. But because the United States Preventive Services Task Force, which dictates what must be covered under the Affordable Care Act, has determined in preliminary recommendations that mammograms are unnecessary under age 50, coverage of mammograms for those under 50 may be in danger.
As this demonstrates, the American Cancer Society isn't the only authority on when to get mammograms. A number of organizations have issued different guidelines, some that recommend more testing and some that recommend less. The United States Preventive Services Task Force only recommends mammograms every other year from ages 50 to 74. The American College of Obstetricians and Gynecologists, on the other hand, recommends mammograms once or twice a year from ages 40 to 49 and once a year after that, in addition to clinical breast exams every year starting at age 19.
Clearly, these standards are somewhat subjective, so how you should proceed depends on what your priorities are. Those who want to err on the side of caution should still be able to get mammograms in accordance with the most cautious recommendations and not have to worry about the cost. But those who only want to worry about things that are absolutely necessary and save themselves the potential stress of false-positive results can probably feel free to take mammograms off their to-do list if they are below 45 and without risk factors. After all, the American Cancer Society would not issue guidelines that put anyone at significant risk.
But I have to say this is one instance when I've been glad I read the comments. The ones in the New York Times' coverage of the mammogram debate persuaded me that if there's even just a chance more tests could save my life, it may be worth the minor hassle.
