For the first time in over ten years, the American Cancer Society (ACS) is changing its guidelines for breast cancer screenings. On October 20th, the largest private, not-for-profit funder of cancer research announced that they are changing their recommendations to call for women who are at an average risk for breast cancer to start receiving mammograms at age 45 instead of the previously suggested age of 40. Additionally, they now suggest that when women reach age 55, they begin getting mammograms every two years as opposed to annually. They also recommend against clinical breast exams, which is when your doctor feels your breast for any lumps, if women have no symptoms of abnormalities.
At first glance, these changes seem counterintuitive. Breast cancer is the second most commonly diagnosed cancer in women as about 12% of American women will develop invasive breast cancer over the course of their lives. Why should we be encouraging women to get screened less than they already do?
The American Cancer Society says that the changes come as a response to increasing evidence that mammograms are less accurate for younger women and can actually produce negative effects. They point to evidence from a 2011 study published by the American College of Physicians that found that women who began receiving mammograms at age 40 had a 61% chance of receiving a false positive over 10 years. For those who received mammograms every other year, those odds dropped to 42%.
False positives are harmful to women because not only do they cause an intense emotional strain, they can also lead to additional tests. More mammograms, biopsies, radiation, chemotherapy, and surgery should not be undergone unless there is a serious health problem. Women who get misdiagnosed are more likely to be subjected to these tests and procedures even if they don’t actually need to be.
Additionally, for women ages 40-44, the chances of developing breast cancer over the next five years is 0.6%. Experts say that this percentage is not significant enough to merit yearly mammograms, but that once the odds jump to 0.9% at age 45, yearly screenings are more justifiable.
As for clinical breast exams, experts also say there is not enough evidence that they are significantly effective in detecting breast cancer and that these exams also lead to more false-positives.
It is also important to note that the United States Preventive Services Task Force, which is comprised of an independent panel of experts, stated that the benefit of yearly mammograms under the age of 50 is relatively small, and so they gave it a rating of a “C.” The Affordable Care Act does not cover services that are rated at a “C,” and so many women of a certain age would not even be able to receive coverage for these services.
The ACS emphasizes that these new recommendations are only for women of average breast cancer risk. Those who are at high risk due to family history, the BRCA1 or BRCA2 genetic mutations, or a number of other conditions should receive mammograms and MRIs yearly beginning around age 30.
Overall, the new recommendations stress that these are just recommendations. If a woman would like to receive breast cancer screenings yearly beginning at age 40, she is allowed to do so. Screening should continue as long as the woman is in good health and expected to live at least 10 years.
The main takeaway from these changes is that women should always be aware of benefits, limitations, and potential harms associated with breast cancer screenings, as well as how breasts are supposed to look and feel. If you are confused or concerned about any of these aspects, you should sit down for a talk with your doctor to determine what the best prevention and detection methods for you are. Remember, health care is not a “one size fits all” system. It is important to know what the best options are for you.
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