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Confusion reign after the USPSTF changed its recommendations on mammography, suggesting that most women start routine scans at age 50 and reduce the frequency to every two years.

Some women were relieved; others were angry and worried that insurers would cut back on coverage for screening.

Annals of Internal Medicine, the medical journal that first published the new guidelines last November, suggests that a divide has emerged between doctors and patients - with the doctors more inclined to accept the new recommendations and the patients wanting to stick to early and annual mammography.

The editorial was based on responses from patients, doctors and other health care workers to the journal’s request for online comments on the new guidelines. Most of the 345 doctors who responded said they would stop offering routine mammograms to women in their 40s, and most said they would advise women 50 to 74 to have mammograms only every other year.

By contrast, most of the 241 patients who responded said they did not believe in giving up routine mammograms in one’s 40s - even if the doctor recommended a change - and were not likely to switch to an every-other-year routine.

Dr. Lori J. Heim, a hospital-based general practitioner based in Laurinburg, N.C., who is president of the American Academy of Family Physicians, said she was already having such discussions. She cited a woman in her 40s who had had several mammograms, each leading to detection of a suspicious lump, a biopsy, a stressful wait and, eventually, a reassuring result.
So when it came time to schedule her annual mammogram, the woman consulted several doctors for advice.

So far there is no indication that any insurers have cut back on mammography coverage, said Susan Pisano, spokeswoman for America’s Health Insurance Plans, the national association representing health insurers. “My understanding is that when a physician orders a mammogram, there’s coverage,” she said.

She and Dr. Laine both noted that the new guidelines left room for individual decisions. And they do not change the recommendations for early and annual mammograms for women with unusual risks for cancer.

Dr. Laine said that now that the dust has settled there’s a better understanding of what the task force was saying. It was not saying, ‘Don’t ever get a mammography if you’re 40.’ It was saying that in the younger age groups the balance of risks and benefits is not clear in one direction.

Source: The New York Times

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