The American Cancer Society (ACS) has updated its recommendations for breast cancer screening for women at average risk of the disease. The recommendations support the value of mammograms and provide some further direction for women at both ends of the age spectrum.
“That was probably the most important take-home message,” says Sandhya Pruthi, M.D., a Mayo Breast Clinic physician and Mayo Clinic Cancer Center researcher. “The benefit of mammography has been shown to reduce death from breast cancer and women who are screened do get that benefit.”
Breast cancer is the most common cancer among women and the second deadliest cancer for women, behind lung cancer. More than 230,000 women in this country are expected to be diagnosed with breast cancer this year.
The new guidelines, released in the Journal of the American Medical Association, pertain to women at average risk. Among the key updates:
Women aged 45-54 should have annual mammogram screening. (The previous guidelines recommended annual mammograms starting at age 40.)
Women 55 and older should have mammograms every two years.
Clinical breast exams—where doctors or nurses feel for lumps in women of any age who have no symptoms or abnormalities—are no longer recommended.
“We have been recommending for years that women in their forties be screened annually with mammogram,” Dr. Pruthi says. “So it’s nice to have the American Cancer Society supports what we’ve been telling patients at Mayo Clinic.”
Dr. Pruthi does say she was surprised, however, that the ACS no longer recommends clinical breast exams by physicians for women of average risk. “I think that’s a little unfortunate, because there’s always an opportunity where the doctor may feel something that’s a little different on a clinical breast exam and a mammogram may not see it,” she says, “because we know that mammograms still may have a difficult interpretation, especially in dense breast tissue.”
Not everyone is pleased with the new recommendations. Breastcancer.org disagreed with ACS, saying that for many women risk is underestimated, “poorly understood, and it’s often inconsistently assessed over time.” And though the guidelines were issued with concerns of overtreatment in mind, delaying detection can mean more aggressive treatments and lives lost.
The guidelines also don’t take into account the value of new technology, such as 3-D mammography (also known as tomosynthesis), to breast cancer screening. “Tomosynthesis has been shown to find more of the invasive cancers, the ones that almost everyone agrees are more likely to be clinically significant since they have the potential to metastasize,” said Emily Conant, M.D., chief of breast imaging at the University of Pennsylvania Medical Center. “Our study at the University of Pennsylvania on tomosynthesis actually showed that the cancer detection rate went up significantly in women ages 40 to 49 while we simultaneously reduced the number of false positives.”
And the Black Women’s Health Imperative issued a strongly worded statement calling out the ACS for adding to the confusion surrounding the mammogram issue and for ignoring the breast cancer health disparities between black women and white women. The statement reads, in part:
“We know that black women receive late-stage diagnosis more frequently than other women, leading to higher mortality rates. We know that younger black women under the age of 40 are being diagnosed with breast cancer at increasingly higher rates, and are on average three to five years younger than white women when diagnosed. We know that the studies on which the ACS and the U.S. Preventive Services Task Force (USPSTF) recommended guidelines are based fail to be representative of black women and their experiences, contain data from 25 years ago, and use technology no longer in use.
“The Black Women’s Health Imperative must again say that these guidelines miss the mark.”