Confused over breast cancer screening guidelines?
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October has come and gone, but a lot of those pink ribbons haven't gone away. Many Americans have taken the message of Breast Cancer Awareness Month to heart, often due to a personal experience with the disease. They have made fundraising for more research and promoting screenings a year-round cause. But recent news has left many women confused about when to get screened for breast cancer and whether their annual mammogram is really necessary.
Late last month, the American Cancer Society (ACS) announced a shift in its recommendations for breast cancer screenings, which had previously stated that women with an average risk of breast cancer undergo a mammogram and clinical breast exam every year, starting at age 40.
For several years, researchers and health care providers have debated over breast cancer screening guidelines and at what age women should be screened, given concerns that annual mammograms for most women age 40 and over have led to too many false positives and unnecessary treatment and anxiety.
Yet many health care providers say the overwhelming evidence shows that mammograms save lives and have positively impacted survival rates of breast cancer over the last 20 years. To them, the benefit of catching cancer early outweighs those potential downsides.
According to the ACS, more than 230,000 cases of invasive breast cancer are projected to be diagnosed this year, and more than 40,000 people are expected to die of the disease in 2015, a mortality rate that has been steadily decreasing since the 1990s. Most experts attribute this drop largely to early detection and treatment of breast cancer at its earlier stages, when chances of survival are better.
All this could leave the average woman scratching her head and wondering how to make the important decision of whether to be screened or not to be screened for breast cancer.
What the new ACS recommendations say
According to the new guidelines, women with an average risk for breast cancer, including no family history or other risk factor for the disease, can:
- Delay their first mammogram until age 45
- Begin to undergo biennial mammograms at age 55
ACS researchers also concluded that "evidence does not support routine clinical breast examination as a screening method for women at average risk."
However, they were also careful to strongly support mammography's role in saving lives and say that women should have the opportunity to get annually screened beginning at age 40, if that's what they choose to do.
Long-term implications for delaying mammograms
Radiologist Patricia Miller, M.D., FACR, who heads breast imaging services at Henry Ford Health System, fears the long-term effects these new recommendations could have for women.
"The unfortunate result of the revised ACS guidelines may be that insurance companies will be less likely to pay for annual mammography for all women and that some women will choose not to screen annually beginning at age 40 because of conflicting recommendations," says Dr. Miller. "The result will be an increase in late stage cancers that may require more intensive treatment than would have been necessary if diagnosed at an earlier stage."
She notes that 17 percent of cancers diagnosed at Henry Ford are in women under 50, and that of all cancers diagnosed, 75 percent of women have no risk factor other than being female.
While overdiagnosis, false positives and the associated anxiety are issues to be considered, many groups including the American College of Radiology (ACR), Society of Breast Imaging (SBI) and even the ACS agree that overdiagnosis claims are inflated due to key methodological flaws in many studies. They also agree that the vast majority of the 10 percent of women asked to return following an inconclusive mammogram, often termed a "false positive," simply get another mammogram and/or an ultrasound for clarification. Only 1 to 2 percent of women have a needle biopsy as a result of a screening mammogram.
Short-term anxiety from test results, though normal, is shown to have no lasting effects. In fact, published research shows that nearly all women who experience a false-positive exam endorse regular screening and want to know their status.
The best advice? Talk with your doctor
If you have questions about what cancer screenings are right for you and when and how often you should have them done, having a conversation with your primary care doctor or provider is the best place to start.
He or she can discuss your personal cancer risk and any potential downsides to getting screened so that you can make the most informed decision about your health.
Need a primary care physician? Find one at henryford.com/findadoc or call 1-800-HENRYFORD (436-7936).
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This story is provided and presented by our sponsor Henry Ford Health System.