Many of our patients have asked us about the recently publicized new guidelines for mammogram frequency. We know this is very confusing since different agencies make different recommendations, and currently 3 different organizations have published recommendations on mammogram frequency, the latest being from the American Cancer Society (ACS). The new ACS guidelines published in October 2015 were as follows:
- Women with an average risk of breast cancer – most women – should begin yearly mammograms at age 45.
- Women should be able to start the screening as early as age 40, if they want to.
- At age 55, women should have mammograms every other year – though women who want to keep having yearly mammograms should be able to do so.
- Regular mammograms should continue for as long as a woman is in good health.
- Breast exams, either from a medical provider or self-exams, are no longer recommended.
- The guidelines are for women at average risk for breast cancer. Women at high risk – because of family history, a breast condition, or another reason – need to begin screening earlier and/or more often.
These new guidelines fall somewhere in the middle between the guidelines released by the US Preventative Services Task Force (USPSTF) in 2010 and the guidelines recommended by the American College of Obstetrics and Gynecology (ACOG). The USPSTF made drastic changes in its recommendations for frequency of Mammography (MMG) screening in low risk patients, and this met great resistance amongst practicing Gynecologists. For instance, the USPSTF advocated not initiating screening until the age of 50, screening only every 2 years and cessation of screening in all women around the age of 74. ACOG (who we generally agree with) made no changes to its guidelines for Mammography screening, and we continue to suggest mammograms every 1-2 years in the 40’s based on the individual situation then annually after age 50, and patients considered to be high risk are offered screening even earlier than age 40. ACOG (and CWCC) felt that the USPSTF recommendations could allow for a missed opportunity to find early stage cancer in young healthy woman, as well as healthy woman in their late 70s and even 80s when the risk of breast cancer is still relevant. As a positive, the new ACS guidelines factor in the importance of patient education and individual discussion with your physician regarding your specific risk. Factors that make patients low risk include few family members with history of breast or other cancers, no personal history of abnormal lumps, or history of abnormal MMG findings.
It is important to remember that both ACS and USPSTF factor in many variables when making these recommendations including cost of screening, patient access to screening, number of cancers detected and lives saved. Many practicing gynecologists feel that delaying initial screening until the age of 45 and then spacing out screening to every 2 years in woman in their 50s will miss the opportunity to detect cancer at an earlier, generally less aggressive stage, improving patients’ ability to successfully fight the disease. So at CWCC, we share the opinion of most gynecologists that the ACOG recommendations for regular mammography starting at age 40 is still the safest and best option. We will continue to do annual breast exams, although we agree that it is very unlikely to feel an early breast cancer, and for those patients following the guidelines for mammography, any cancer would be picked upon the mammogram before it can be felt. So while we recognize that breast exam has very little use, it can occasionally be helpful.
We remind our patients that 1 in 8 women will fight breast cancer during her life. Think of sitting at lunch with 8 women, one of us will fight breast cancer. Our goal as gynecologists should be to recommend screening that allows us to detect early stage cancer that we know has the best survival rates. Mammography, albeit uncomfortable, is safe and our best chance at detecting early stage cancer before it is big enough to feel.