The American Cancer Society has released new guidelines for breast cancer screening. Among the changes, the new recommendations say all women should begin having yearly mammograms at age 45, and can change to having mammograms every other year beginning at age 55.
But this new change, while a relief to some, brings confusion to the issue, and angers some survivors. The confusion comes from the face that three key groups — the American College of Obstetricians and Gynecologists, the American Cancer Society, and the U.S. Preventive Services Task Force — recommend different ages for starting regular mammograms: 40, 45 and 50 respectively. The reason for that? Everyone agrees that while mammograms save lives, they can also cause harm, and each group does a different job of balancing the pros and cons.
The new American Cancer Society recommendations
• Women with an average risk of breast cancer – most women – should begin yearly mammograms at age 45.
• Women should be able to start the screening as early as age 40, if they want to.
• It’s a good idea to start talking to your health care provider at age 40 about when you should begin screening.
• At age 55, women should have mammograms every other year – though women who want to keep having yearly mammograms should be able to do so.
• Regular mammograms should continue for as long as a woman is in good health.
• Breast exams, either from a medical provider or self-exams, are no longer recommended. Still, the American Cancer Society says all women should be familiar with how their breasts normally look and feel and report any changes to their health care provider right away.
• The guidelines are for women at average risk for breast cancer. Women at high risk – because of family history, a breast condition, or another reason – need to begin screening earlier and/or more often.
Talk to your medical provider to be sure.
Earlier testing is not necessarily better
The goal of screening mammograms is to find breast cancer early, when treatment is more likely to be successful. But mammograms aren’t perfect, and they have a relatively high false positive rate. In these cases mammograms find something suspicious that turns out to be harmless, but must be checked out through more tests that also carry risks including pain, anxiety, and other side effects. Experts weigh these benefits and risks when making recommendations about who should be screened.
An exhaustive review of the medical literature shows these measures just aren’t very effective, according to the group. “The chance that you’re going to find a cancer and save a life is actually very small,” said Dr. Otis Brawley, the society’s chief medical officer.
The chances of false positives are especially high for women under 45, as they have denser breasts and tumors are harder to spot on an image. “If she starts screening at age 40, she increases the risk that she’ll need a breast cancer biopsy that turns out with the doctor saying ‘You don’t have cancer, so sorry we put you through all this,’” Brawley said.
He said he knows women who’ve had false positives year after year. “False positives are a huge deal,” he said. “These women are so frightened and inconvenienced they swear off mammography for the rest of their lives.”
“We know that debates will continue about the age to start mammography,” said Dr. Wender. the Society’s Chief Cancer Control Officer, “This guideline makes it so clear that all women by age 45 should begin screening – that’s when the benefits substantially outweigh the harms.”
New guidelines have their critics
While agreeing with the American Cancer Society that mammograms aren’t perfect, according to an CNN interview some advocates for women criticized the group’s new guidelines. First, they said the society looked mostly at studies of film mammography, which in the United States has almost been entirely replaced by digital mammography.
Digital mammograms generate clearer images and do a better job of finding cancer and have a lower false positive rate. “It’s like standard versus HD TV,” said Dr. Therese Bevers, the chair of the National Comprehensive Cancer Network’s guidelines panel for breast cancer screening and diagnosis, and the medical director of the Cancer Prevention Center at the MD Anderson Cancer Center.
Second, critics said the cancer society looked only at whether screening saved a woman’s life, and not at whether screening caught a cancer early, so the woman could avoid the most drastic treatments, such as chemotherapy or mastectomy.
“The American Cancer Society made the value judgment that screening is only worth it if improves survival,” said Dr. Marisa Weiss, a breast cancer survivor and president of Breastcancer.org. “There’s an arrogance to that. Let women decide what’s meaningful to them.”
Insurance companies will make the final decision
While the new guidelines state that women over age 55 can choose to get a mammogram every other year, since breast cancers in post-menopausal women tend to develop more slowly to a great extent it will be insurance companies that decide at what age women get mammograms. In 2009, they typically continued to pay for mammograms starting at age 40 even though the government’s task for force recommended mammograms starting at age 50.
But it’s not clear what they’ll do now that the American Cancer Society has also raised the age for mammograms. “(Insurance) plans will certainly take these updated recommendations into account when evaluating their coverage policies,” Clare Krusing, a spokeswoman for America’s Health Insurance Plans, wrote to CNN.
Talk to your doctor
For now the best way to know when to begin screening for mammograms and how often to get screenings is to talk to your medical provider.
• Begin talking to your medical provider about breast cancer screening by age 40.
• Share your family history and personal medical history to determine whether you are at average risk or higher risk for breast cancer.
• Understand the benefits, risks, and limitations of breast cancer screening. Mammograms will find most, but not all breast cancers.