American Cancer Society Reinforces Importance of Beginning Mammograms at 40

After major medical qroup challenges value of screening in younger women

The American Cancer Society (ACS) has reaffirmed its recommendation for all women to begin routine annual mammograms when they turn 40. The ACS underscored its position in response to a different viewpoint taken recently by the country’s largest medical specialty group, questioning the value of mammograms for women in their 40’s as a blanket screening guideline.

Mammograms are breast x-rays that can detect tumors when they are too small to be felt by hand. The smaller the tumor and the earlier it is found, the better are a woman’s chances of survival. Breast cancer is the most common cancer among women besides non-melanoma skin cancer. About 178,000 women are expected to develop the disease this year and about 40,000 are expected to die from it. Breast cancer is the second-leading cause of cancer death in women. It tends to be especially deadly when it strikes younger women.


The American Cancer Society and other groups including the National Cancer Institute, endorse mammograms for women starting at 40 as a regular part of their health care. “There is both direct and inferential evidence showing mammograms from age 40 reduce deaths from breast cancer,” says Kapi‘olani Breast Radiologist Bryan Gushiken, M.D

But the American College of Physicians (ACP), which represents 120,000 internists, says a review of mammography research suggests that the benefits are less clear for women in their 40’s than for those in their 50’s and older. The ACP emphasizes discussing a woman’s individual risk of breast cancer in deciding whether she should get screened.

On the other hand, the American Cancer Society maintains support for early screening and detection. “Although most breast cancers are found in women who are 50 and older, about 17 percent of invasive breast cancers occur in women in their 40’s,” says Gushiken. “If we were to screen only those women in their 40’s who had known risk factors, we would miss the majority of cancers in this age group.”

In addition, predicting breast cancer risk is not an exact science. Most women with diagnosed breast cancer have none of the known risk factors of family history, breast density or genetic mutations. Gushiken notes that a woman’s breast health concerns are commonly managed by her OB/GYN. “If a woman is diagnosed with breast cancer, it will be her gynecologist directing her care and referring her to specialists for treatment.” The American College of Obstetricians and Gynecologists, which is the professional association for OB/GYN physicians, also supports screening from age 40.

“The benefit from routine screenings starting at age 40 is clear. It is a drop in breast cancer deaths,” says Gushiken. On the flip side, the ACP lists the potential downsides as possible pain during mammogram, a small amount of radiation (less than most routine dental x-rays), and the anxiety that accompanies resultswhich at first look positive for cancer and then turn out to be negative.

A spokesman for the American College of Physicians acknowledged that the benefit of mammograms will probably outweigh other concerns for most women in their 40’s.

The American Cancer Society expressed concern that the ACP guidelines may lead to confusion and cause some women to skip the tests. “It would be a major public health setback if these new guidelines caused some women and their doctors to conclude that screening can safely be postponed,” said an ACS spokesman.


For further information, visit the American Cancer Society site at www.cancer.org.