New mammography guidelines from the American College of Physicians suggest women 40 to 49 years old should talk with their doctor before making a decision to undergo the breast examination.

The guidelines, meant to be used by practicing physicians, are published in the April 3 issue of the Annals of Internal Medicine.

The guidelines don't agree with some recommendations issued by other medical groups. In 2006, the American Cancer Society recommended annual mammograms for women beginning at age 40. And the U.S. Preventive Services Task Force recommends screening mammography every one to two years for women 40 and older, noting there wasn't enough evidence to specify the best screening interval for women 40 to 49.

"I hope what (the new guidelines) will do is allow women to have the sorts of conversation that discusses for them personally, the risks and benefits of a screening mammogram," said Dr. Lynne Kirk, president of the American College of Physicians.

The discussion should ideally include a family history of breast cancer, whether the woman has had a previous breast biopsy to check for cancer, and other factors, added Kirk, a professor of internal medicine at the University of Texas Southwestern Medical Center at Dallas.

"We had not done a specific recommendation on women 40 to 49," she said. "We had recommended for women 50 and over, every year or every other year."

Kirk said she doesn't think the new guidelines will discourage women from having the exam.

"My guess is, a lot of women will choose to have a mammogram based on this discussion," she said.

The college committee in charge of drafting the guidelines reviewed 117 studies to evaluate the evidence on the risks and benefits of mammography screening for women in the 40-to-49 age group.

In an editorial accompanying the guidelines, the authors concluded "no simple recommendation applies to all women in their 40s." The best strategy, they wrote, is for physicians to listen carefully to patients and to communicate to them "the benefits and limitations of our imperfect tests."

Dr. Cheryl Perkins, senior clinical adviser for Susan G. Komen for the Cure, a Dallas-based organization devoted to fighting breast cancer, said setting mammogram guidelines for women in the 40-to-49 age range is difficult.

"It's a very diverse age group," she said. "Some are still child-bearing, some are perimenopausal, some are menopausal."

Breast cancer is the most common cancer among women, other than skin cancer. It's the second-leading cause of cancer death in women, after lung cancer. An estimated 178,000 women in the United States will be diagnosed invasive breast cancer in 2007, and about 40,000 women will die from the disease.

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