New mammography advice follows PSA changes

News that a federal advisory panel recommends women don't start breast screening until age 50 comes from a government advisory group that changed the recommendations for PSA testing last year.

Just last month the chief medical officer of the American Cancer Society said the advantages of cancer screening had been exaggerated, especially for breast and prostate cancers. He told the New York Times that screening for those diseases had led to overtreating small cancers while missing others that are more deadly.

Now the U.S. Preventative Services Task Force recommends women in their 40s should stop having routine mammograms, relying instead on self-examination.

Although the American Cancer Society doctor gave us a preview of this decision, that group and the American College of Radiology, among others, are officially disputing the recommendation.

Livestrong president Doug Ulman said:

"We must break down the barriers to screening and early detection, not create new ones. We must empower women to be well-informed about their health, not send them conflicting signals."

Fortunately, the decision on whether to get a mammogram is the decision of a woman, advised by her doctor.

One danger mentioned in the New York Times, however, is that insurance companies may one day adjust their coverage of mammograms based on the new recommendations.

Last year, the task force changed the guidelines for prostate cancer screening. It stopped endorsing universal screenings and recommended against them for men over 75 years old.

Generally speaking the American Cancer Society does not support routine testing of prostate cancer. However, the group does recommend that doctors should discuss screening with men who are of average risk for prostate cancer at age 50; earlier for men with close relatives who suffered prostate cancer.

Here's the full language of the American Cancer Society recommendation for prostate cancer screening [it's part of the ACS discussion of early prostate cancer detection]:

The American Cancer Society (ACS) does not support routine testing for prostate cancer at this time. The ACS does believe that health care professionals should discuss the potential benefits and limitations of prostate cancer early detection testing with men before any testing begins. This discussion should include an offer for testing with the prostate-specific antigen (PSA) blood test and digital rectal exam (DRE) yearly, beginning at age 50, to men who are at average risk of prostate cancer and have at least a 10-year life expectancy. Following this discussion, those men who favor testing should be tested. Men should actively take part in this decision by learning about prostate cancer and the pros and cons of early detection and treatment of prostate cancer

This discussion should take place starting at age 45 for men at high risk of developing prostate cancer. This includes African Americans and men who have a first-degree relative (father, brother, or son) diagnosed with prostate cancer at an early age (younger than age 65).

This discussion should take place at age 40 for men at even higher risk (those with several first-degree relatives who had prostate cancer at an early age).

If, after this discussion, a man asks his health care professional to make the decision for him, he should be tested (unless there is a specific reason not to test).