Why the Latest Breast Cancer Screening Advice May Not Be for You

We’ve all come to equate screening for breast cancer with saving lives. But new recommendations issued Tuesday by the American Cancer Society (ACS) advise most women to get fewer mammograms, not more. And the recommendations say your doctor does not need to perform a routine breast exam during your annual well-woman visits – ever.
The new ACS guidelines are based on multiple studies that repeatedly show mammograms reduce a woman’s risk of dying from breast cancer. The guidelines say:

• Women should have mammograms every year beginning at age 45 until they are age 54, and then they can consider switching to every other year.
• Women between the ages of 40 and 44 should be offered the opportunity for a mammogram if they prefer.
• Women should continue mammograms as long as their overall health is good and their life expectancy is 10 years or more.
• A clinical breast exam is unnecessary as part of an annual checkup.

It’s important to know that the new ACS recommendations, which were published Tuesday in the Journal of the American Medical Association, are directed at women with an average risk of developing breast cancer. That means women who have:

• No history of breast cancer
• No genetic mutation, such as BRCA1 or BRCA2, that predisposes them to breast cancer
• No radiation therapy to the chest between the ages of 10 and 30

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What’s going on here?

The ACS last released screening mammography recommendations in 2003, says Laura Shepardson, MD, Associate Director of Breast Imaging at Cleveland Clinic.
“Since then, there have been multiple research studies done that the ACS used to support their recommendations, and the health care market now expects patients to understand the risks, benefits and limitations of screening mammography programs,” Dr. Shepardson says.
These many research studies that have repeatedly shown that regular screening mammography reduces a woman’s risk of dying from breast cancer. There is no debate about that, Dr. Shepardson says.
But medical opinions diverge on when a woman with an average risk of developing breast cancer should start getting mammograms and how often to get them.
“We understand this is extremely confusing for patients and their doctors, since there are multiple sets of recommendations and guidelines out there now,” she says.
This is why it’s so important for a woman to understand what risk factors she has for developing breast cancer, and to understand the benefits, risks, and limitations of mammograms in the context of her personal medical history and preferences, Dr. Shepardson says.
RELATED: Mammograms Still Have the Power to Save Your Life

False positives

Chief among the concerns over when to get a mammogram is the risk of false positives.  A false positive means an abnormality is identified on the screening mammogram that requires additional evaluation, including a possible biopsy to rule out cancer.  This can cause a woman significant anxiety.  Some women get false positives from mammograms every year.
On the other hand, some women say a false positive, despite the inconvenience and sometimes painful follow-up, is worth it if screening improves the chance of finding a cancer, particularly one that is early and small, which gives the woman more treatment options.  This is one reason why the ACS recommendations allow for younger women to decide, in conjunction with their physicians, when to start mammograms and how often to get them, Dr. Shepardson says.
Another concern about mammograms, Dr. Shepardson says, is that they may encourage over-diagnosis – when very early or slow-growing breast cancer is detected via a mammogram and then treated, without any certainty whether the disease might have an impact on a woman’s life if left alone.
“Right now, physicians are unable to tell which breast cancers are going to progress and which aren’t,” Dr. Shepardson says. “Until our science catches up, we are going to have cases of over-treatment.”
RELATED: Mammograms Save Lives — But They Can Get Better

Know your risks, weigh the benefits

For women who are at average risk of developing breast cancer, Cleveland Clinic physicians recommend a baseline mammogram starting at age 40 and then every year afterward, and that you and your doctor should decide whether you should get a mammogram earlier if you are at high risk, meaning:

• You have had breast cancer before
• You have the genetic mutation that predisposes you to breast cancer
• You’ve had radiation therapy to the chest between the ages of 10 and 30

“A woman needs to know what her individual risk factors are and what the risks, benefits and limitations of screening mammography are,” Dr. Shepardson says. “Using that information in conjunction with her values and preferences for her own care, a woman and her clinician should be able to come up with an appropriate screening schedule.”