Despite new recommendations, women in 40s continue to get routine mammograms at same rate

Insurance coverage for annual screening likely one reason for persistence

2013-05-15

(Press-News.org) Women in their 40s continue to undergo routine breast cancer screenings despite national guidelines recommending otherwise, according to new Johns Hopkins research.

In 2009, the U.S. Preventive Services Task Force (USPSTF) sifted through the evidence and recommended that while women ages 50-74 should continue to undergo mammograms every two years, those between the ages of 40 and 49 without a family history of breast cancer should discuss the risks and benefits of routine screening mammography with their physicians to make individual decisions.

As a result of the altered recommendations, Lauren D. Block, M.D., M.P.H., a clinical fellow in the Division of General Internal Medicine at the Johns Hopkins University School of Medicine, and her colleagues expected to find fewer women in their 40s getting routine mammograms. Instead, they found no impact on mammography rates among younger women.

"Patients — and likely their providers — appear hesitant to change their behavior, even in light of evidence that routine screening in younger women carries substantial risk of false positives and unnecessary further imaging and biopsies," says Block, leader of a study published online in the Journal of General Internal Medicine. "Women have been bombarded with the message 'mammograms save lives,' so they want them no matter what."

That research has shown that mammography's impact on younger women is mixed at best: routine screening increases rates of detecting cancer in young women, but reduces mortality risk by a very small percentage. It is more likely, studies show, to result in over-diagnosis, and unnecessary treatment, including biopsies, lumpectomies and mastectomies, and weeks of radiation and potentially toxic drugs. False positives result in avoidable procedures and psychological trauma. Many of the cancers detected will probably never be dangerous, but are aggressively treated.

Among older women, screening mammograms are recommended because breast cancer, like most cancer, is a disease of aging, and a woman's risk of breast cancer increases as she grows older.

The original USPSTF guideline change recommended more forcefully against routine screening for women in their 40s, but a political and advocacy group backlash resulted in compromise language that counseled individual decision-making by patients and physicians. The American Cancer Society continues to recommend yearly mammography for women starting at age 40.

Moreover, Block says, insurance companies continue to pay for routine mammograms for women in their 40s — a likely reason for the persistently high rate of screening.

Block and her colleagues analyzed mammogram use data from Behavioral Risk Factor Surveillance System surveys administered in 2006, 2008 and 2010 by state health departments nationwide. Data from 484,296 women ages 40 to 74 were collected. Among women in their 40s, 53 percent reported having a mammogram in the past year in 2006 and 2008, compared with 65 percent of women ages 50 to 74. In 2010, after the new recommendations had been in effect, 52 percent of younger women and 62 percent of older women reported having a mammogram.

The USPSTF recommendations also say there is no benefit to screening women at normal risk of breast cancer over the age of 75.

Block says she sees the same reluctance among her 40-something patients to change course on mammography when she has the conversations about the pros and cons. Some of her patients are relieved that they can postpone mammography until age 50. Many more, however, want to continue being screened.

"Breast cancer gets so much attention in the media and in society in general, despite cardiovascular disease being by far the number one killer in women. Everyone wants to feel as though they are preventing breast cancer," Block says. "You hear one anecdotal story about someone in their 40s who found cancer during a mammogram and did really well with treatment and that's enough to fly in the face of any other facts that are out there. Women want the test."

### Other Johns Hopkins researchers involved in the study include Marian P. Jarlenski, M.P.H.; Albert W. Wu, M.D., M.P.H.; and Wendy L. Bennett, M.D., M.P.H.

ELSE PRESS RELEASES FROM THIS DATE:

Scientists develop 'green' pretreatment of Miscanthus for biofuels

2013-05-15

URBANA –Two University of Illinois scientists have developed an environmentally friendly and more economical way of pretreating Miscanthus in the biofuel production process. "We pretreat the biomass with switchable butadiene sulfone in the presence of water to break down the plant cell wall, which consists of cellulose, hemicellulose, and lignin, the source of biofuels and value-added products," said Hao Feng, a U of I professor of food science and human nutrition who also has extensive research experience with biofuels. The new technique is a green alternative to current ...

Pelvic organ prolapse surgery less effective than expected

2013-05-15

SALT LAKE CITY – Research conducted by the Pelvic Floor Disorders Network, an initiative funded by the National Institutes of Health, has revealed that the long-term success rates of a surgery to treat pelvic organ prolapse are lower than expected. Nearly one-third of women develop anatomic or symptomatic treatment failure within five years of undergoing sacrocolpopexy for pelvic organ prolapse, according to a study published in the May 15 issue of JAMA. "Each year, 225,000 women in the United States undergo surgery for pelvic organ prolapse, but little is known about ...

Robotic transplant an option for obese kidney patients

2013-05-15

Obese patients who received robotic kidney transplants had fewer wound complications than patients who received traditional "open" transplant surgery, according to surgeons at the University of Illinois Hospital & Health Sciences System. The findings should allow more obese patients to receive kidney transplants. Patients with a body mass index (BMI) greater than 35 who have end-stage kidney disease are often denied transplantation, and patients with a BMI over 40 often die on dialysis without an opportunity for transplant. Obesity "markedly increases the risk of wound ...

Community Catalyst responds to ADA oral health campaign

2013-05-15

BOSTON – "Lack of access to dental care in the United States has reached epic proportions. Dental disease is the number one chronic illness affecting children – more common than asthma. The Institute of Medicine clearly states that the current dental delivery system doesn't work for a third of the people in the U.S. "The American Dental Association survey and report confirm the extent of the problem, but the association's recommendations for combating the problem are sorely lacking in one area: the refusal to include midlevel dental providers in the fight to expand access ...

Fall warming on Antarctic Peninsula driven by tropically forced circulation

2013-05-15

The eastern side of the Antarctic Peninsula, a finger of the southern polar continent that juts toward South America, has experienced summer warming of perhaps a half-degree per decade – a greater rate than possibly anywhere else on Earth – in the last 50 years, and that warming is largely attributed to human causes. But new University of Washington research shows that the Southern Hemisphere's fall months – March, April and May – are the only time when there has been extensive warming over the entire peninsula, and that is largely governed by atmospheric circulation ...

Community groups & neonatal mortality in Vietnam

2013-05-15

Community groups in rural Vietnam comprised of local health workers, politicians and laywomen (Maternal and Newborn Health Groups) set up to tackle challenges to maternal and neonatal health may reduce the neonatal death rate after three years and increase antenatal care attendance, according to a study by researchers from Sweden and Vietnam published in this week's PLOS Medicine. These findings are important as they show that is it feasible to implement community-based activity into the public sector system at low cost. The researchers, led by Lars-Åke Persson from ...

Asymptomatic carriage of M. pneumoniae common in children

2013-05-15

The bacterium M. pneumoniae is carried at high rates in the upper respiratory tracts of healthy children and usual diagnostic tests cannot differentiate between such asymptomatic carriage and actual respiratory tract infection, according to a study by Dutch researchers published in this week's PLOS Medicine. These findings are important as they suggest that clinicians may need to reconsider the clinical significance of a positive test result for the presence of this bacterium. The researchers, led by Annemarie van Rossum from Erasmus MC–Sophia in Rotterdam, The Netherlands, ...

Implementation research & child diarrhea

2013-05-15

While considerable recent progress has been made against childhood diarrheal diseases, the number of children dying from diarrhoea remains unacceptably high. This week, PLOS Medicine publishes a report based upon the work of over 150 international experts who convened to review and discuss research priorities to address this global problem. Zulfiqar Bhutta from the Aga Khan University in Pakistan and colleagues report that the most important priority is for more research on implementation of known interventions. Research questions involving improving implementation, especially ...

Mental health & NCDs

2013-05-15

Non-communicable diseases (NCD) and mental disorders each constitute a huge portion of the worldwide health care burden, and often occur together, so they should be addressed together. These are the conclusions of the third article in a series published in PLOS Medicine that provides a global perspective on integrating mental health. Victoria Ngo from the RAND Corporation in California and international colleagues say that collaborative care models, where NCD care and mental health care are integrated and provided in the primary care setting, are effective for patients, ...

Surgery for common woman's condition may not be effective over long-term

2013-05-15

MAYWOOD – The initial success rates of the most durable surgery for a common condition in women declines over the long-term, according to data published today in the Journal of the American Medical Association. The procedure, abdominal sacrocolpopexy, is used to manage pelvic organ prolapse, a widespread but little-known condition that occurs when the vaginal wall protrudes outside of the vaginal opening. More than 225,000 surgeries are performed annually in the United States for pelvic organ prolapse. The cost for these procedures is more than $1 billion per year, ...

Despite new recommendations, women in 40s continue to get routine mammograms at same rate

ELSE PRESS RELEASES FROM THIS DATE:

LAST 30 PRESS RELEASES: