Alice Goodman

June 06, 2011

June 6, 2011 (Washington, DC) — Women aged 39 to 49 years question the wisdom of the changes in the US Preventive Service Task Force (USPSTF) guidelines for mammography released in 2009, recommending that the age for screening be increased from age 40 years to age 50 years, and that mammogram frequency change from yearly to every other year.

Exposure to negative press increased skepticism, regardless of physicians' advice, according to a survey of women presenting for annual mammography exams in private practices. Findings of that survey were presented here at the American Congress of Obstetricians and Gynecologists (ACOG) 59th Annual Clinical Meeting.

The majority of participants greatly overestimated their lifetime risk of developing breast cancer, survey results showed. The authors attribute this misperception to high media exposure.

Women who had previous false-positive mammograms were less likely to accept the new guideline changes.

"There has been a backlash against the November 2009 changes in mammography guidelines from the USPSTF, with most women having a negative reaction to the proposed changes to increase the age for beginning screening from 40 to 50 years and to have biennial mammograms instead of annual ones," explained lead author AuTumn Davidson, MD, a third-year obstetics/gynecology resident at the University of Massachusetts in Worcester.

The evidence-based USPSTF recommendations were partly based on the number needed to treat of 1800 to prevent 1 new case of breast cancer, Dr. Davidson explained. Arguments favoring the new guidelines included decreasing radiation exposure throughout a woman's lifetime, reducing the numbers of false-positive tests and subsequent unnecessary work-ups, and reducing the psychological consequences associated with a false-positive result.

The study enrolled 244 women aged 39 to 49 years who presented for annual mammography screening to 1 of 4 private practices in Worcester, Massachusetts. Participants were given a survey on demographics and previous experience with mammography. Participants were then randomly assigned to read 1 of 2 articles from the lay press: 1 article supported the new guidelines, and 1 opposed the changes.

Pros and Cons

After reading the article, participants were asked to answer 3 more questions reflecting their opinion of the changes in the 2009 guidelines:

  • Do you feel you should have yearly mammograms in your 40s?

  • Do you feel these guidelines are safe?

  • Would you feel comfortable delaying mammograms until age 50 if your physician felt this was reasonable in your case?

The main findings of the survey were that 78% of women overestimated their lifetime risk of breast cancer as being between 13% and more than 36%; only 12% knew what the true lifetime risk was (11%).

"We attribute this overestimation to media exposure," Dr. Davidson said.

Women who read the favorable news article were more likely to agree with the new recommendations for mammograms starting at age 50 years, whereas those who read the negative article were less likely to agree (P < .05). A similar but nonsignificant trend was observed for feeling that the new guidelines were safe; the women in this group supported delaying mammograms until age 50 years if their physician recommended it.

After reading the articles in the lay press, 89% of the participants said that they should have yearly mammograms in their 40s despite the guideline changes, but this belief was stronger among those who read the negative article (92% in the negative article group vs 85% in the positive article group); 86% felt the new guidelines were unsafe (89% in the negative article group vs 83% in the positive article group).

Participants who had a close friend or family member with breast cancer were more likely to reject the guideline changes. Participants who had a previous false-positive mammogram were less likely to adhere to the new guidelines than those who never had a false-positive mammogram, despite their physician's recommendation.

"This study opens our eyes to the influence of the lay press," said Julia Johnson, chair of the Department of Obstetrics and Gynecology at University of Massachusetts in Worcester.

"The changes in the USPSTF guidelines made women think about the importance of about mammography screening. The guidelines were well done based on evidence-based medicine with cost-benefit in mind," Dr. Johnson said. In her practice, however, she chooses to inform women about the changes and the evidence that they were based on, but continues to offer yearly mammograms routinely to women after age 40 years.

Dr. Davidson and Dr. Johnson have disclosed no relevant financial relationships.

American Congress of Obstetricians and Gynecologists (ACOG) 59th Annual Clinical Meeting: Abstract 127. Presented May 3, 2011.

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