Women in their 40s should get annual mammograms and those at high-risk for developing breast cancer should consider preventive drug treatments and surgery, a panel of doctors recommended Wednesday.

The guidelines, presented at the 19th Annual Miami Cancer Conference, stem from a 2001 survey of some 600 breast surgeons, said Dr. Eva Singletary, chief of breast surgery and a professor of surgical oncology at the University of Texas.

The survey showed that many of the physicians were not routinely using a patient's risk factors for breast cancer to predict their chances of developing the disease, Singletary said.

The panel suggests doctors follow a diagnosis and treatment plan based on what breast cancer risk factors a patient has.

Among the guidelines:

— Patients who are at an average risk of getting breast cancer should get routine physicals and a yearly mammogram beginning at age 40.

— Those patients with elevated risk factors should also consider taking tamoxifen, an estrogen-blocking drug that has long been used to help prevent cancer from coming back after surgery and chemotherapy. Those risk factors include having a close relative diagnosed with breast cancer, a breast biopsy that revealed atypical cells or having been on estrogen-progesterone replacement therapy for 10 years

— Physicians treating patients in the highest risk group should consider surgery to remove ovaries or cancerous breast tissue along with a five-year regimen of tamoxifen. These high-risk patients have been diagnosed with breast cancer, may be carrying the BRAC1 or BRAC2 gene or have a history of other risk factors.

Singletary said a relatively new procedure called ductal lavage, which involves flushing out the milk-carrying ducts in the breasts and examining the cells that come out, could help doctors and patients decide whether to go on tamoxifen.

"Women who do not have breast cancer should be focusing on risk assessment and prevention," said Singletary. "What we hope with the guidelines is that we can customize for each patient what they should consider doing."