You may have heard that the American Cancer Society (ACS) has published new guidelines on breast cancer screening. The last guidelines are 12 years old so it is time for an update based on current understanding of the value versus the risk of breast cancer screening.
According to the report published in JAMA, screening mammograms can reduce deaths from breast cancer. Breast exams done routinely do not decrease mortality.
These guidelines apply only to women at average risk of breast cancer, which is most women.
They are not used for high risk women- women with
- a history of previous breast cancer
- a suspected or confirmed genetic mutation known to increase breast cancer risk
- a history of radiation to the chest
- a close family history of breast history, usually meaning parent, sibling, grandparent, aunt/uncle, or cousin.
Screening guidelines also do not apply to women with breast symptoms suggestive of cancer.These women need appropriate diagnostic testing which might include mammography, ultrasound, MRI, and/or biopsy.
In summary, here are the new guidelines from the ACS-
- Offer annual screening to women age 40 to 44 years.
- Perform a mammogram annually in women 45 to 54 years.
- Perform a mammogram annually or every other year starting at age 55 years.
- Continue screen mammography as long as a woman’s overall health is good, with a life expectancy of 10 years or longer.
- Routine breast exams by either the patient or a physician are not recommended.
These are guidelines for physicians to apply to each individual patient, not hard and fast rules. Some physicians may choose to follow the guidelines of the U.S. Preventive Services Task Force (USPSTF)
- For ages 40-49 years, individualize the decision to screen every 2 years
- For ages 50-74 years, screen every 2 years
- For ages 75 years and older there is no recommendation.
Both organizations recommend that physicians discuss the decision to screen or not to screen with patients and base the decision after considering possible harms versus potential benefit.
And while breast cancer is the second leading cause of cancer death among women in the United States, it is treatable and the chance of long term survival is high.