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Confusion Over New American Cancer Society Breast Cancer Screening Guidelines

by JoAnn Pinkerton | Nov 23, 2015

There’s plenty of controversy surrounding the American Cancer Society’s (ACS) updated breast cancer screening recommendations for average-risk women (those without a family history or without dense breasts). The new guidelines recommend that the minimum age to start mammograms should be 45 instead of age 40 and that mammograms be done for women age 55 and older only every other year rather than every year. However, the ACS did qualify their recommendations, saying that women may begin mammograms at age 40 or have annual mammograms at age 55 and older if that’s what they want. The ACS also said that breast exams are not ever recommended.

Not everyone agrees with the ACS recommendations, including the American Congress of Obstetricians and Gynecologists, which continues to support yearly mammograms starting at age 40 as well as having a healthcare provider examine your breasts. Although some research supports the ACS guidelines, not all of it does, as breast-imaging specialist Jennifer Harvey, MD, outlined for NAMS. Regular mammograms reduce breast cancer deaths up to 48% for women ages 40 to 79, she says. She also points out that a high proportion of breast cancer deaths are in younger women, because they tend to have more advanced cancers and their tumors grow faster.

Proponents of the ACS guidelines cite the anxiety that false-positive mammogram results can cause as one reason for the changes, but Dr. Harvey says that this is usually just temporary and reminds us that finding breast cancer earlier may decrease the amount of treatment needed. For example, it can make the difference between having just a lumpectomy or needing additional therapies such as radiation, chemotherapy, or antiestrogen therapy. As for women age 55 and older, Dr. Harvey says, it’s difficult to figure out who is at average risk. It’s harder to see cancers in dense breasts, raising the risk of missing cancers. Depending on their risk, women who have dense breasts are candidates for 3D-tomosynthesis or other screening modalities that show more than regular mammograms but do have more radiation exposure.

Although annual mammography increases radiation exposure and increases risk of false alarms, mammography saves lives. Today, it is difficult to predict who has an early cancer that won’t progress, although that is being researched. If you want to have the best chance of detecting breast cancer early or if you are at higher risk because of your family history or you have dense breasts, you should discuss with your provider what your best screening starting age and frequency should be.

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JoAnn V. Pinkerton, MD, NCMP
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