Take the guidelines for what they are—guidelines—and make the decision that's right for you.

Women not at high risk don't need screening mammograms before age 50, a government task force says.

RODALE NEWS, EMMAUS, PA—A government panel just released new breast-cancer-screening guidelines that recommend, among other things, an end to mammograms for most women under age 40. The recommendations have been criticized by some health-advocacy organizations, welcomed by others, and been construed in some quarters as being politically motivated in light of the ongoing healthcare reform debate.

The new guidelines, published yesterday in the Annals of Internal Medicine, were issued by the U.S. Preventive Services Task Force (USPSTF), a group that operates independently under the Agency for Healthcare Research and Quality in the Department of Health and Human Services. The group analyzes published studies and generates recommendations on a variety of topics that balance the benefits of a preventive service with any risks associated with its use. For these guidelines, the group looked at medical studies on mammograms and other breast-cancer-screening methods to determine how effective they were at preventing breast-cancer deaths.

THE DETAILS: The USPSTF recommends biennial screening mammography for women aged 50 to 74 years. Their report concludes that the current evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years or older, and states that the decision to start regular biennial screening mammography before the age of 50 should be an individual one and take patient context into account, including the patient’s specific benefits and risk of harm. Their prior recommendation had been biennial mammography screenings for women between 40 and 49, and annual screenings after that, which has become current guidelines used by most health agencies.

The task force notes that mammography screening of women in their forties detects only a small number of preventable cancers, but the benefits of those few detections are far outweighed by the number of potential adverse consequences of mammograms—unnecessary biopsies, anxiety over waiting for test results, and cancer treatments that may not be needed.

Their rationale for the new recommendations is that not all of these diagnostic tests are effective, and some screenings lead to false-positive test results and overdiagnosis, both of which may lead to psychological distress and unnecessary, expensive, and invasive surgeries or harmful radiation treatments. These consequences are more likely for women in their 40s, the report notes. The rate of prevented deaths for mammography among women age 40 to 49 is one in 1,904. The success rate is higher in women over 50—one in 1,339. Their analysis also found that mammography screening between the ages of 50 and 69 years led to a 17 percent reduction in breast-cancer deaths, but they saw just an additional 3 percent reduction when screening began at age 40.

In addition, the Task Force recommends against teaching breast self-examination, due to the fact that one study found that self exams, which aren't as sensitive at detecting tumors as other methods, led to more biopsies and imaging procedures than women who didn't perform them.