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Annual Mammograms at Age 40 is the Standard, says Top Radiology Group

According to recommendations from the American College of Radiology (ACR) and the Society of Breast Imaging (SBI), average-risk women should begin annual breast cancer screening with mammograms at age 40, and higher-risk women should begin by age 30, but no sooner than 25, the ACR and SBI recommend in guidelines published in the January issue of the Journal of the American College of Radiology.

The significant decrease in breast cancer mortality is due largely to earlier detection of breast cancer through mammography screening.

The recommendations conflict with those issued  last year by the U.S. Preventive Services Task Force (USPSTF), which suggested that routine screening begin at age 50. The task force also recommended screening every other year, not annually.

In addition to the recommendations related to age and screening intervals, the ACR-SBI guidelines integrate use of breast MRI and ultrasound into the screening algorithm.  They say carriers of BRCA mutations should begin annual breast MRI evaluations by age 30. Women who have at least a 20% lifetime risk of breast cancer, on the basis of family history, also should begin annual breast MRI by age 30, in addition to annual mammography.

The guidelines state that breast ultrasound might be considered, in addition to mammography, for high-risk women and those with dense breast tissue that is often difficult to assess by conventional mammography.

In its debate on healthcare reform legislation, the Senate essentially overruled the task force by approving an amendment that would mandate insurance coverage of mammography for women ages 40 to 49.  Moreover, the Senate approved an amendment to the amendment, making the task force's 2002 recommendation -- which suggested that annual mammography begin at age 40 -- the operative standard.