Screening for Breast Cancer | New Breast Cancer Screening Guidelines
More Advice For Older Women And Women At Increased Risk
Older women, women with serious health problems, and those at increased risk for breast cancer will get more specific advice about breast cancer screening under updated guidelines released Wednesday night by the American Cancer Society.
The guidelines advise doctors and patients on the proper intervals for mammograms and breast exams in an effort to detect breast cancer early, when it is most likely to be treatable. They are published in the journal CA: A Cancer Journal for Clinicians (Vol. 53, No. 3: 141-169).
Despite recent controversies over its usefulness, especially in women under age 50, mammography is still considered to be the gold standard for early detection of breast cancer, experts said.
“Women and doctors need to understand that we are more confident than ever in the benefits of mammography,” said Debbie Saslow, PhD, director of breast and gynecologic cancers for the American Cancer Society. “The benefit is particularly clear for women in their 40s. We have much more evidence, and much more convincing evidence, that those women benefit.” For this reason, the basic screening recommendation remains unchanged. Women are still advised to get a mammogram every year, starting at age 40.
But the new guidelines put more emphasis on educating women especially those at increased risk for breast cancer about the benefits and limits of mammography and other screening methods.
Under the old guidelines, for instance, women with a higher than average risk for breast cancer (those who have already had the disease, or who have a family history of it, or with a genetic mutation that greatly increases their risk of developing it) were advised to discuss screening with their doctor.
The updated guidelines are more specific about who is at increased risk and their options for screening. Now, women and their doctors are encouraged to discuss the possibility of beginning screening earlier (at age 30, or in rare cases even younger). Another option might be to consider screening with breast ultrasound or MRI in addition to their regular mammogram.
“If you know you are at increased risk, there is no question that the way you approach screening should be different,” said Amy Langer, executive director of the National Alliance of Breast Cancer Organizations (NABCO), and an 18-year survivor of breast cancer.
Older women, too, are now provided with more specific advice about screening.
The previous guidelines did not address the issue of how long a woman should continue to get screened for breast cancer. The risk of getting the disease increases with age, but many older women also have serious health conditions that make screening less practical and beneficial for them.
“As long as a woman is in good health, she should continue getting routine mammograms,” Langer said.
But women with chronic health problems, serious illnesses, or a short life expectancy may not get the same benefit from screening as healthy women because they may not be able to pursue treatment if breast cancer is found, Langer noted.
The updated guidelines urge doctors and women to consider these issues when deciding whether to continue mammograms as a woman ages. However, the guidelines note that age alone is not a reason to stop screening.
Guidelines Incorporate Newest Science for Breast Cancer
This is the first major change in the breast cancer screening guidelines since 1997, when the Society began recommending annual mammograms for all women starting at age 40.
All American Cancer Society screening guidelines are revised regularly, typically every five years, to take account of new scientific findings and developments.This revision of the breast cancer screening guidelines also includes information about new and emerging screening technologies.The updated guidelines recognize that mammography is still the gold standard for screening, and new technologies must equal or exceed its performance in order to be recommended as screening tools. There are a number of technologies, such as breast ultrasound and MRI (magnetic resonance imaging) that, when used with mammography, may enhance the effectiveness of screening and diagnosis. However, none of these used alone is appropriate for breast cancer screening. Ongoing and future clinical trials will allow for further study and development of new technologies.
Other ACS Breast Cancer Screening Guidelines
In addition to its mammography guidelines discussed above, ACS continues to advocate the following breast cancer screening guidelines:
1. Clinical breast examination should be done about every 3 years for women in their 20s and 30s and annually for women aged 40 years and older.
2. Women should promptly report to their healthcare providers any change they notice in their breasts. Breast self-examination is also an option beginning at age 20 years.
3. For women at more than 20% lifetime risk for breast cancer, magnetic resonance imaging (MRI) and mammography should be performed every year. Women at 15% to 20% lifetime risk should consult with their physicians about the benefits and limitations of adding MRI screening to their annual mammogram.
4. For women whose lifetime risk for breast cancer is less than 15%, annual MRI screening is not recommended.
The ACS also provides a comparison of its recommendations with the new USPSTF recommendations:
Comparison of Breast Cancer Screening and recommendations
|Cancer Screening Age||ACS Recommendations||New USPSTF Recommendations|
|40 – 49 years||Annual mammograms are recommended starting at age 40 years and continuing for as long as a woman is in good health. There is no specific upper age at which mammography screening should be discontinued. Rather, the decision to stop regular mammography screening should be made on an individual basis based on the potential benefits and risks of screening within the context of a patient’s overall health status and estimated longevity.||“C Grade”: Recommends against routine screening mammography in women aged 40 to 49 years.|
|50 – 74 years||“B Grade”: Recommends biennial screening mammography for women between ages 50 to 74 years.|
|?75 years||“I Grade”: Insufficient to assess the additional benefits and harms of screening mammography in women aged 75 years and older.|