The American Cancer Society on Tuesday updated its guidelines on breast cancer screening, recommending that most women begin annual mammograms at age 45 and switch to every two years starting at age 55.
The new recommendations are a departure from the society’s previous guidelines, which called for annual mammograms beginning at age 40. The American Congress of Obstetricians and Gynecologists still calls for annual mammograms for women 40 and older.
The U.S. Preventive Services Task Force, meanwhile, recommends that women at average risk get annual mammograms between the ages of 50 and 74. The task force is an independent group of national experts.
Why is there such confusion? And what should women do, particularly those who might be at a higher risk for breast cancer? WebMD asked Laura Shepardson, MD, a radiologist at Cleveland Clinic and an expert in breast imaging, to help make sense of the differing recommendations.
WebMD: Why do we keep hearing conflicting guidance on breast cancer screening?
Shepardson: In an era where health care providers are strongly encouraged to practice evidence based medicine, it is important to regularly review and update recommendations for screening and treatment strategies as more data is published and treatment strategies improve and/or change in response.
The field of breast cancer is no different. The American Cancer Society last updated their breast cancer screening guidelines in 2003. This most recent revision in recommendations is necessary as more data from trials and studies is now available. In addition, patients and providers are expected to compare the risks and benefits of screening programs and use these recommendations along with with the patient’s values and preferences to make the appropriate informed decisions.
WebMD: What should women do now?
Shepardson: Breast cancer is the second leading cause of cancer death in women in the United States. And although treatment strategies have certainly improved a woman’s chance for survival, early detection also plays a significant role since earlier stage disease will afford the patient more treatment options and potentially impact her quality of life less than that necessary to treat later stage disease. However, if a woman chooses to start her regular screening earlier (at age 40 versus 45), and chooses to screen every year after age 55 (despite recommendations to screen every other year), she must be willing to accept she will likely have false positive screening mammograms that require additional exams and perhaps biopsy. In other words, she must be willing to accept the benefit of catching a cancer earlier at the risk of false positive exams which can lead to extra anxiety.
Recommendations are just that – recommendations. Certainly a woman can and should make decisions about her own health with the guidance of her doctor. Therefore, it is not as important for a woman to understand all the different recommendations and guidelines of the varying medical societies as it is for her to know what her individual risk factors are as well as the benefits, risks, and limitations of screening mammograms. With that information, a woman and her doctor can make the best decisions about the most appropriate screening schedule for her.
WebMD: What if a woman has risk factors?
Shepardson: It is important to remember that these new American Cancer Society recommendations are only for those patients who are at average risk. For those patients who have a greater lifetime risk of breast cancer the American Cancer Society still recommends annual mammography and MRI beginning at age 30.
A woman’s risk for developing breast cancer increases if she has one or more of the following factors:
1. Known BRCA1 or BRCA2 gene mutation
2. First degree relative (mother/daughter/sister/brother) with a BRCA 1 or BRCA 2 gene mutation
3. Personal history of radiation to the chest between the ages of 10 and 30
4. Personal history or first degree family member with a condition that may predispose them to cancer.
It is important for every woman to review her risk factors with her doctor and compare the benefits with the “harms” of screening mammography before making the decision when to start/stop screening and how often to screen for breast cancer.