Tag Archives: USPSTF

Breast cancer screening and treatment: One size doesn't fit all. bras hanging on a clothes line

Mammograms-who, when, and why

During Breast Cancer Awareness Month I want to remind you of physician recommendations for screening. Currently, the only test recommended for screening is mammography.

a woman having a mammogram done by a technician

image used courtesy of the Public Health Image Library, CDC

No other test has evidence that its use will decrease breast cancer deaths, although they may be useful for diagnosis in women who have breast symptoms.

These guidelines for screening  apply only to women at average risk of breast cancer, which is most women. They do not apply to women who have ever been diagnosed and/or treated for breast cancer, or to women who currently have symptoms related to their breasts, such as a lump, pain, discharge, or skin changes.

Guidelines for screening come chiefly from two organizations- The American Cancer Society (ACS) and the United States Preventive Services Task Force (USPSTF). Other organizations such as the American Academy of Family Physicians (AAFP) , of which I am a member, usually follow their recommendations .

 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.

 guidelines from 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.These are guidelines for physicians to apply to each individual patient, not hard and fast rules.

a mammogram image

a mammogram revealing a breast cancer image source- National Library of Medicine, Open-i

Screening guidelines  are not used for high risk women- women with 

  • a history of previous breast cancer or ovarian cancer
  • a suspected or confirmed genetic mutation , BRCA, known to increase breast cancer risk
  • a history of radiation to the chest
  • a close family history of breast history, usually meaning parent, sibling, child, grandparent, aunt/uncle, or first cousin.
Breast cancer in young women can be hereditary.

graphic courtesy of the CDC, U.S. Department of Health and Human Services

Screening guidelines also do not apply to women with breast symptoms suggestive of cancer.

  • a lump in the breast or axilla (armpit)
  • pain, especially in only one breast
  • nipple discharge
  • persistent rash or skin changes over the breast

These women need appropriate diagnostic testing which might include

  • mammography,
  • ultrasound,
  • MRI, 
  • biopsy. 

Here are sources for more information

Breast Cancer

“Both women and men can get breast cancer, though it is much more common in women. Other than skin cancer, breast cancer is the most common cancer among women in the United States.”

Mammography 

“You should talk to your doctor about the benefits and drawbacks of mammograms. Together, you can decide when to start and how often to have a mammogram.”

Screening Guidelines

“Mammograms are not perfect tests. They can miss some cancers, and they can find lesions that may look like cancers but are not actually cancers (false-positive results), resulting in additional testing and procedures. They can also find very low-risk cancers that would never have caused any health problems if they were never found or treated (overdiagnosis).”

Breast cancer screening benefits and harms 

“Each woman also has different personal values, especially toward the idea of unnecessary medical tests and treatments.

Talk to your doctor if you are younger than 50 years and have questions about whether you should get a mammogram.”

 

 

 

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When should a woman have a mammogram?

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. 

woman having a mammogram

photo from Medline, National Library of Medicine

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.

Here are sources for more information

Breast Cancer

Mammography 

Screening Guidelines

Breast cancer screening benefits and harms