How often is it actually useful to have a mammogram? A common recommendation, like that of the American Cancer Society, is to get screened every one to two years beginning at age 40. More recently, the U.S. Preventive Services Task Force (USPSTF) advised a less stringent schedule: screening for women ages 40 to 49 should be based on individual risk factors, while women ages 50 to 74 should get screened every two years. Now a paper in the Annals of Internal Medicine asserts that guidelines need to take into consideration the risk profiles of each patient on an individual basis.
Dr. Steven R. Cummings, senior author of the study and senior researcher at the California Pacific Medical Center, identifies personal risk factors as age, breast density, and family history of breast cancer and believes that patients and doctors should weigh all of these together to determine the best screening schedule. Dr. Cummings stresses that, because breast density is the strongest risk factor that we know of, and because physicians are able to analyze the relationship between breast density and the risk of getting breast cancer very, very accurately, such individualized guidelines are a real possibility.
While ACSH's Dr. Gilbert Ross agrees that individualized guidelines are ideal, he observes that they re difficult to actually put into practice. It s easy, he notes, to advise flexibility based on well-documented risk factors for screening mammography but so hard to put into practice. Remember the firestorm unleashed by the fairly cautious revisions suggested in 2009 by the USPSTF? And those who advocate such changes never seem to take the lurking plaintiffs' lawyers into account. Doctors are loath to have to defend themselves against charges that they ignored established guidelines even if a new approach is science-based.