The U.S. Preventive Services Task Force (USPSTF) is recommending sweeping changes in its breast cancer screening guidelines.

The USPSTF, which is a group of independent health experts convened by the Department of Health and Human Services, reviewed and commissioned research to develop computer-simulated models comparing the expected outcomes under different screening scenarios.

Here are the USPSTF's recommendations, based on all that work:

• Routine screening of average-risk women should begin at age 50, instead of age 40.
• Routine screening should end at age 74.
• Women should get screening mammograms every two years instead of every year.
• Breast self-exams have little value, based on findings from several large studies.

But the new recommendations may leave some women confused, since the American Cancer Society continues to recommend annual mammographyscreening for all healthy women beginning at age 40. What's the bottom line on mammogram screening? WebMD asked breast cancer experts about the new USPSTF screening guidelines.

If a woman younger than 50 or older than 74 wants to get a screening mammogram, can she?

The guidelines don't ban anyone from getting a screening mammogram. But it's not yet known if the new guidelines will affect mammography coverage by insurance companies and other providers.

Task force vice-chair Diana B. Petitti, MD, tells WebMD the new guidelines don't apply to women with risk factors for breast cancer, such as BRCA mutations or a close family history of the disease.

She adds that they also do not mean average-risk women who are younger than 50 or older than 74 should never be screened.

"This is not telling [average-risk] women in these age groups they can't get screened," Petitti says. "A woman who still wants to be screened after having the conversation with her clinician and considering the balance of benefits and harms should absolutely be screened."

Will insurance pay for a mammogram if I'm younger than 50 or older than 74?

As for paying for those mammograms, the USPSTF recommendations are influential in guiding policy, but the group doesn't make specific recommendations about reimbursement.

It remains to be seen if the sweeping health care bill now being considered by Congress will reflect the new recommendations.

American Cancer Society national volunteer president Elizabeth T.H. Fontham, MD, says there is a good chance that Medicare and private insurers will stop paying for annual mammogram screenings and screening for women in their 40s and over 74.

"Ultimately, this could increase economic disparities associated with breast cancer screening," Fontham says. "Women who want to be screened and can pay for it can still get screened. But those who can't pay may be out of luck."

What if I find a lump and I'm younger than 50 or older than 74?

The new guidelines are just about routine screening mammograms. They're not about getting a mammogram when you have a lump or other suspicious finding or if you're at high risk of breast cancer.

Any woman, of any age, should get a suspicious lump or other breast change checked out.

 

The new guidelines recommend against breast self-exams and question the benefits of clinical breast exams performed by health care providers. Why?

Two major studies, one from China and another from Russia, found no evidence that breast self-examinations reduced deaths from breast cancer, but that the practice leads to additional screening and biopsies.

"The self-exam data were pretty definitive," Pettiti says. "There is high certainty that there is no benefit, and there are harms which include unnecessary anxiety from finding something that isn't cancer."

But that doesn't mean a woman should ever ignore a suspicious lump.

"That definitely is not the message," Petitti says. "Anything unusual should be checked out."

The USPSTF panel concluded the current evidence is insufficient to assess the risks and benefits of clinical breast exams performed by health care providers.

Evers says she will continue to recommend breast self-exams.

"I don't think the practice is useless," she says. "For many women it is important because it helps them feel somewhat empowered and in control of their own breast health."

What should average-risk women in their 40s be doing if mammography and self-exams are no longer recommended?

Although the experts interviewed for this story had different opinions about whether routine screening is advisable, they all agree that any woman concerned about breast cancer should discuss her own situation with her doctor or other health care provider.

The new guidelines don't apply to women at high risk for breast cancer. How often should these women get screened?

The new guidelines aren't about women at high risk of breast cancer.

The American Cancer Society defines high-risk as women with a greater than 20% lifetime risk of breast cancer. This includes women with BRCA1 and BRCA2 gene mutations and women who have not been tested but have a parent, sibling, or child with a BRCA mutation, as well as certain other groups of women.

The ACS recommends that high-risk women have annual mammograms along with an MRI beginning at age 30 and continuing for as long as they are in good health.

Women with a 15% to 20% lifetime risk for breast cancer are considered to have a moderately increased risk for the disease.

ACS recommends that these women talk to their doctors about the benefits and risks of adding MRI to annual mammogram screening.

If a woman's breast cancer risk increases with age, why stop screening at 74?

Very few breast cancer screening studies include women in their mid-70s and older. The task force noted that "breast cancer is a leading cause of death in older women, which might suggest that the benefits of screening could be important at this age."

However, the USPSTF also concluded that the benefits of screening are probably not as great for older women because they tend to have breast cancers that respond well to treatment and have a higher risk of dying from other causes.

The panel noted that the risk of overdiagnosis and unnecessary treatment is greater in elderly women than in younger ones because of their increased risk for death from other causes.
 

Do the new guidelines apply to women taking hormone therapy?

The panel did not address this question. Hormone therapy increases a woman's risk for breast cancer. The general consensus among the experts who talked to WebMD was that women on hormone therapy should discuss annual screening with their doctors.