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Yearly mammograms urged after age 40

CHICAGO -- One side recommends yearly breast cancer screenings for women over 40. The other side says tests can come as much as two years apart. In the middle are the people most affected: patients and insurers who must pay for the procedures.

Switching sides in one of the most contentious issues in medicine, the American Medical Association on Thursday recommended all women get yearly mammograms starting at age 40.The recommendation, supported by the American Cancer Society and the American College of Surgeons, could lead to pressure on insurers and managed-care companies to pay for more mammograms.

It also 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.

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 paying for them.

Dr. Debra Judelson of Beverly Hills, Calif., a representative of the American Medical Women's Association, which supports annual screening, said managed-care companies have refused to pay for mammograms at less than two-year intervals for women under 50.

"The science does show us that cancers in this age group grow more rapidly," she said. "We do want to identify the disease early. But I cannot get all of my patients getting a yearly mammogram if they wish it, because the companies will only cover every two years."

She said insurers always translate "every one or two years" as meaning they only have to pay for mammograms every two years in younger women.

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 Reiling, a spokesman for the American College of Surgeons, told the AMA's 494 policymaking delegates before they voted in favor of the change.

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