The debate over when women should start getting mammograms and how often they should get them took another turn Tuesday when the American Cancer Society updated its guidelines in an article in the Journal of the American Medical Association.
The organization pushed back its suggested age that women be screened for breast cancer and made changes to how often it recommends they be tested.
So what are the new recommendations?
The American Cancer Society now recommends:
- Women at average-risk for breast cancer start getting annual mammograms between ages 45 and 54. That's a change from the Cancer Society's previous (2003) guidelines, which advised women to start getting screened at age 40.
- Women get mammograms every two years after age 55, continuing that regimen as long as they are healthy and have a life expectancy of at least 10 years. The old guidelines said women should get screened annually as long as they are in good health.
- Average-risk women of all ages should not get a clinical breast examination. This is a change from the previous guidelines, which called for periodic exams for women in their 20s and 30s, and annual exams for women 40 and older.
Why did the Cancer Society change its guidelines?
- The organization said research found a similar risk and incidence of breast cancer for women 45-54.
- The Cancer Society concluded that the benefits (preventing breast cancer deaths) outweigh the harm (more false-positive results, which can lead to unnecessary tests, procedures and stress) among younger women, leading to its support for annual checks for the 45-54 age group.
- It found the relative benefits of annual screening are diminished after menopause and as women get older. Instead, it recommended women get tested biennially after 55. ]
- The Cancer Society said its research found "a lack of evidence showing any benefit of a [clinical breast examination] alone or in conjunction with screening mammography." Given the time constraints of a typical appointment, the guidelines say doctors should use this time to take a family history and counsel the patient on the risks and benefits of mammography.
How does this affect the screening debate?
The Cancer Society's new recommendation that annual screening begin at 45 brings it closer to the guidelines of the U.S. Preventive Services Task Force, which published a draft update of its 2009 recommendations earlier this year. The Task Force, a U.S. government-backed independent panel of experts, recommends:
- Women at average risk should begin mammography screening every two years starting at age 50.
- Women should get screened every two years between ages 50 and 74. Beyond that age, it finds "current evidence is insufficient to assess the balance of benefits and harms" of continued mammography.
- When it comes to using clinical breast examination to supplement mammography, the Task Force says "evidence is lacking and the balance of benefits and harms cannot be determined."
What do other groups say?
- The American College of Physicians recommends that women 40-49 only get a mammography after a thorough discussion with their doctor; it believes "the benefits of mammography do not clearly outweigh the potential harms" for that age group, so "women should be fully informed rather than routinely screened."
- The American Congress of Obstetricians and Gynecologists recommends annual screening beginning at 40.
Who is considered at "high risk?"
According to the National Institutes of Health's National Cancer Institute, about 1 in 8 women will develop cancer in their lifetime. That also means 7 out of 8 won't. Risk rises with age; there are other factors that increase risk, including:
- Having a family history of breast cancer
- Having a personal history of breast cancer
- Having a BRCA1 or BRCA2 gene mutation
- Having radiation therapy to the chest between the ages of 10 and 30
Here's a handy tool to determine your risk. Note that it's developed for doctors, but you can print out your results and discuss them with your health care provider.
So what's the bottom line for women?
"The differences [in] recommendations represent different ideas about balancing the benefits and the potential harms of screening," Dr. Jill Jin writes on the JAMA Patient Page.
Most importantly, every organization that has weighed in on this issue stresses that the ultimate decision must rest with each woman, in consultation with her health care provider.
Here's how the Cancer Society puts it:
"Women should be encouraged to be aware of and to discuss their family history and medical history with a clinician, who should periodically ascertain whether a woman's risk factor profile has changed...The intention of this new guideline is to provide both guidance and flexibility for women about when to start and stop screening mammography and how frequently to be screened for breast cancer."
Mammograms: The basics
Mammograms are used to screen for breast cancer. The goal is to catch cancer early: Early-stage cancers are easier to treat than later-stage cancers, and the chance of survival is higher.
The test is potentially life saving, but it also has its drawbacks:
- It can miss some cancers
- It can misidentify other things as cancer, which leads to false-positive results and spurs unnecessary tests and procedures.
- It can also lead to over-diagnosis, by locating very low-risk cancers that would never have caused any health problems if they were never found or treated.