American Cancer Society revises guidelines for breast screenings


American Cancer Society

On Tuesday, the American Cancer Society recommended changes to its guidelines on screening for breast cancer. Here are the highlights:

At age 40: Begin talking with your medical provider about screening.

At age 45: Annual mammograms begin for most women.

At age 55: Women should have mammograms every other year.

Breast exams: No longer recommended; this includes self-exams.

Women at high risk: Begin screening earlier and more often.

Source: American Cancer Society

Draft recommendations of the U.S. Preventive Service Task Force

Biennial mammograms for women of average risk at ages 50-74.

The group determined that the overall benefits are smaller for women ages 40-49, although it stressed that the decision to have a mammogram then was an individual decision.

Source: U.S. Preventive Service Task Force

American College of Obstetricians and Gynecologists

Screening mammography every one to two years for women ages 40-49.

Screening mammography every year for women age 50 or older.

Breast self-awareness has the potential to detect palpable breast cancer and can be recommended.

Clinical breast exam every year for women age 19 or older.

Source: American College of Obstetricians and Gynecologists

The American Cancer Society on Tuesday revised its guidelines on mammograms, suggesting that women be screened later and, at some point, not as often.

Under the new guidelines, the Atlanta-based organization recommended that women of average risk start regular, annual mammograms at age 45 and screenings every two years starting at age 55.

The recommendations are not ironclad, yet they drew fire. The American Cancer Society left some flexibility in the report, which is published in the Journal of the American Medical Association, that women have options about when to begin screening, and how often to be screened. It said women who are 40-44 should have the option to begin screening before age 45, and women age 55 and older should be able to continue with annual screenings.

“I think we’ve given average-risk women a roadmap that is tailored to their risks and personal preference,” said Dr. Robert A. Smith, vice president of cancer screenings for the American Cancer Society. “Our message is that you can start at 40. It’s your decision if you want that additional insurance. Regular mammograms are like insurance. Most women will not develop breast cancer in their lifetimes, but regular mammograms are a good preventive measure.”

Previously, the recommended age to begin screenings was 40. He said about 6 percent of breast cancers are diagnosed from ages 40-44; 10 percent, ages 45-49; and 12 percent, ages 50-54.

The last time the guidelines were updated was in 2003. He said new evidence on the benefits of screening, including annual vs. biennial screening, helped the organization come up with the recommendations.

It also recommended regular mammograms continue for as long as a woman is in good health but nixed clinical exams.

Insurance companies may use the recommendations for coverage options, Smith said. “It’s a real possibility that some health plans will not make mammography available for women in their 40s. We think many will but some may not and that’s a real concern for us.”

Recommendations from the American Cancer Society carry a lot of weight. It is one of the largest, most generously funded and influential health-related organizations in the nation.

“I think it’s crazy,” said Melissa Miller, a nurse and mother of two who was diagnosed with stage 3 breast cancer at age 38. “It makes no sense.”

The Cobb County woman underwent chemo, surgery and radiation.

Then, her cancer returned last year, this time close to her lungs, in her bones and brain.

She worries that other women will not get screened. “If it’s not recommended, they won’t do it. We know too many people are getting cancer. Why would you want to wait?”

Women at high risk — because of family history, a breast condition or another reason — should begin screenings earlier and more often. It’s recommended that they talk with their physician.

Breast cancer is the most commonly diagnosed cancer in women, besides skin cancer, and is the second biggest cancer killer of women behind lung cancer, according to the American Cancer Society.

About 231,000 women will be diagnosed with breast cancer this year and about 40,000 will die of the disease.

The frequency of breast cancer screenings and when to begin screening have long been a topic of debate.

Dr. Keerthi Gogineni, an assistant professor at the Emory University School of Medicine, thinks the recommendations are more consistent with what other groups have recommended.

“It’s really important to understand that their guidelines are for an average-risk woman,” she said. “These are not for high-risk women. … They are encouraging women to have a conversation with their doctors.”

Some say the changes will be more confusing than helpful.

Dr. Lynn Baxter, director of breast imaging at Northside Hospital, said she's "disappointed" in the changes and worries that some women might be "discouraged from having a mammogram. It might make them think a mammogram is a less valuable tool in diagnosing breast cancer. …

“None of us are really thrilled about getting a mammogram every year and some people may take this and say, ‘Oh, good. Now I have an excuse. I don’t have to get my mammogram now.’ Even women later in life can say, ‘OK, I can skip a year. Maybe three or five.’ They may not understand that a mammogram should be part of your wellness plan.”

Kimberly Goff took to her personal Facebook to voice her displeasure.

She called the study “bunk. I am not a medical professional by a long shot … but I have heard more breast cancer stories than most doctors and mammograms and self breast exams DO save lives. The next one saved could be yours. Get your mammogram and check your breasts each month — you must know your body to save it.”

Goff, 50, is executive director of the nonprofit It’s the Journey, which raises money for breast cancer screenings, treatment, genetic testing and wellness programs. She emphasized that she was not speaking on behalf of the nonprofit.

Goff said she lost a friend in her 30s to breast cancer. “She kept being told that she was too young to have breast cancer. She died at 33.

“I don’t skip mine and I plan to continue to get one every year.”

Other groups have varying recommendations about screenings.

For instance, the U.S. Preventive Service Task Force, an independent panel of volunteer experts in preventive care, released draft recommendations in April suggesting biennial mammograms for women of average risk at ages 50-74.

The group determined that the overall benefits are smaller for women ages 40-49, although it stressed that the decision to have a mammogram then was an individual decision. Although the report found screenings may reduce breast cancer-related deaths, the number of deaths averted is smaller than in older women while the number of false positives and “unnecessary” biopsies are larger.

It found that of all age groups, women ages 60-69 are most “likely to avoid a breast cancer death through mammography screening.”