AMA Urges Mammograms Yearly for Women 40 to 50

Changing its stand on one of the most contentious issues in medicine, the American Medical Assn. recommended Thursday that all women ages 40 to 50 get annual mammograms.

The decision puts the AMA at odds with the government and the American College of Obstetricians and Gynecologists, which say an interval of one to two years is adequate. But the AMA now agrees with the American Cancer Society and the American College of Surgeons.

The issue has pitted those who argue that routine mammograms are not cost-effective in younger women against those who say that the tests are needed and that the insurance industry should be pressured into paying for them.

The AMA had previously advocated the one- to two-year timetable for women in their 40s.

“One in six breast cancer deaths in 1995 were attributable to women diagnosed with breast cancer during their 40s,” Richard B. Reiling, a spokesman for the American College of Surgeons, argued before the AMA’s 494 policymaking delegates voted in favor of the change.

On the other side of the issue was Dr. Scott R. Karlan of the American Society of General Surgeons, who noted that a 10-year study of 25,000 Canadian women found no benefit to mammography for women in their 40s.

“Even the studies that have been in favor of mammography have pointed out that the incidence of breast cancer is so low and the sensitivity of mammography is so low in women from the ages of 40 to 50 that you would have to screen more than 250,000 women to find, perhaps, one curable case of breast cancer,” Karlan said.

Thursday’s vote does not affect AMA recommendations that women older than 50 receive annual mammograms and that a manual breast exam by a doctor be part of any physical exam in either age group.

The AMA’s Council on Scientific Affairs said the cost-effectiveness of screening younger women is in line with that of other diagnostic procedures.