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When to Begin Mammography Screening

Whatever Your Position, Let Patients Know
By Jim Knaub

Virginia Moyer, MD, chaired the U.S. Preventive Services Task Force (USPSTF) that issued the recommendations that women between the ages of 40 and 49 at normal risk of breast cancer make a joint decision with their physician about whether to begin mammograms at age 40.

The ACR, the Society of Breast Imaging, the American Cancer Society, and the American College of Obstetricians and Gynecologists all recommend women at normal risk of breast cancer begin annual mammograms at age 40.

In a world seeking “just-tell-me-what-to-do” clarity, such nuance can cause problems. In the case of the USPSTF mammography recommendations, the term “problem” is an understatement. The furor caused by the recommendations—and particularly the botched presentation of the recommendations—have reverberated through the medical and mainstream media reports on a regular basis since the guidelines’ release in 2009.

"In many, many instances, our recommendation has been interpreted as a 'don't do it.' That is incorrect," Moyer told CNN recently. "It's something that needs to be discussed on an individual basis. For some women, it will be consistent with their values to choose to have a mammogram between 40 and 50. For other women, they will choose not to, and those are both reasonable decisions."

And that’s arguably OK as long as the decision is a conscious one. Some members of the women’s health community believe the confusing reports about when women should begin having routine mammograms has led many to skip them. No one knows to what extent that concern has been realized. But if I’m involved in mammography at my facility, I’m figuring out how marketing efforts can provide the information to help women make that decision. I’m looking for appropriate ways to reach women directly or their physicians in my service area.

If you firmly support routine mammography screening beginning at age 40, advocate that position in your patient and professional communities. The same applies if you’re not convinced of the value of starting mammograms sooner. Even the USPSTF guidelines recommend that discussion, so help drive it.

— Jim Knaub is editor of Radiology Today.