The American College of Physicians issued a new recommendation for breast cancer screening of average-risk women with no symptoms. The evidence-based guidance statement published in Annals of Internal Medicine, says that average-risk women between the ages of 50 and 74 should undergo breast cancer screening with mammography every other year, instead of every year.
However, these recommendations still conflict with other recommendations that suggest annual screening should start and continue for everyone starting at 40.
Dr. Deanna Attai, (pictured above*) assistant clinical professor in the department of surgery at David Geffen School of Medicine at UCLA, is available to discuss the new ACP recommendation and what this means and what women really need to know about breast cancer screening.
Quotes from Dr. Attai:
“These guidelines echo those of the American Cancer Society, the American Society of Breast Surgeons, and the US Preventative Services Task Force, who all recommend every other year screening for women age 50-74 who are at “average risk” for developing breast cancer.”
“The conflicting guidelines do lead to a lot of confusion among women as well as a lot of worry. There is no question that the regular use of screening mammography has resulted in improved survival from breast cancer, but the “early detection saves lives” does not apply to every case – there is much more nuance to all of this.”
“Mammograms work well in women age 50-74 because as women age and go through menopause, the density of the breast usually decreases, so mammograms can “see” cancers better. In addition, as the risk of breast cancer increases with age, this age group is more likely to have a cancer. Younger women have breast tissue that is denser, so mammograms are not as helpful. They are also less likely to have cancer, so you have to perform many more mammograms in a group of younger women to find a single cancer. In addition, in part due to the dense breast tissue, younger women are more likely to have a “false positive” (I describe as “false alarm”) to patients from the mammogram, resulting in biopsy or the need for additional imaging. These are considered to be some of the harms associated with screening in younger women – although patients don’t always see it that way.”
“The goal of screening is to improve the survival from the detected cancer – not just to detect the cancer. A pap, analyzing scrapings of the cervix looking for cancer cells, works just as well in a 20 year old as it does in a 60 year old. With mammography, there are many more variables, and a one size fits all approach does not really work.”
“A balanced discussion with patients is very important. We used to simply recommend mammogram at 40 for all. Currently, there should be a discussion of the potential benefits as well as harms from mammography, as well as consideration of the patient’s perspective in terms of risk tolerance and cancer worry. It should also be stressed again that these guidelines do not apply to high risk patients.”
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ACP issues new mammo screening recommendation. Appl Rad Oncol.