My take on mammograms and NEW recommendations on breast cancer screenings.

So, this week the American Cancer Society released MORE changes in recommendations for when to start doing mammograms. Here was my Twitter post today about it:

So the changes reccs again to starting at age 45 and NO self exams. What do we think about that?

I think I’ll stick with starting at age 40 and teaching women to feel their breasts, if you don’t mind. Thanks.  

Many people had much to say about it. Long story short—we’re all confused, and some of us are angry. Here’s what one person had to say about it:

Rachel Webb   as a current breast cancer patient it makes me angry.

  I can understand why you would be. No worries. We can decide to do what’s comfortable for each patient.

  I feel like they’re telling me that I don’t matter and my death would be acceptable collateral damage.

Let’s be honest…there will always be changes as more medical evidence comes about and cancer rates change. This clearly isn’t the first time the recommendations have changed. Here’s an excerpt from my book, How to Avoid the Superwoman Complex (available on Amazon), that talks about the change made right before this one:

Chapter 10: Cancer Awareness

“October is known as National Breast Cancer Awareness Month, which is one of the most “celebrated” and popular of the cancer awareness causes. It really should be, due to the fact that breast cancer is one of the largest killers and devastating illnesses to affect women…….

…..Newer recommendations recently came out stating that we should not begin doing mammograms for women until age 50yo, and after that only every 1-2 yrs. This is drastically different from our usual starting age of 40yo and doing them every year. I discuss the new recommendations with each of my patients and do what’s comfortable for them given their personal history and family history.

In 2009, new recommendations on mammogram screenings hit, and I have had the discussion frequently as the majority of my time is spent counseling on preventive care. Many of the women asked, “What’s the big mammogram controversy about?” Some felt it might have been a bit of a conspiracy by the government to make or save money. Whatever the question, let’s review what happened. The recommendations were presented by the USPSTF, which is the US Preventive Services Task Force. This is a group of medical experts in primary care that reviews studies and puts together a list of preventive care measures. In 2002, the USPSTF noted that every woman beginning at age 40 should get their first mammogram*. If she had a first degree relative (ie. mother, sister) with breast cancer, she should start even earlier. After the first one, we were told to then have them every 2 years or so. This recommendation was given until age 49. Starting at age 50years, we were encouraged to have them yearly.

Now the recommendation is for “biennial screening mammography for women aged 50 to 74 years”. This means having your first mammogram at age 50years old, and every 2 years after that until age 74. This was also given a “B grade” recommendation score, which means that there is moderate evidence in research supporting it and its benefit. Starting before age 50 has been given a “C grade”, which means the USPSTF does not recommend it routinely. However, they do say to consider each patient as an individual and to always have a conversation about it. After the conversation, if it’s reasonable, a doctor and patient may decide to go ahead and have a mammogram.

So, what’s the “big deal”? The big deal seems to be about unnecessary harm. This means mammograms, like most tests, are not perfect. There are many “false positives”, or in other words, abnormal results that aren’t really abnormal. Just think about it. How would you feel receiving the news that your breast exam was abnormal and then being told you needed another test or a biopsy to make sure you didn’t have cancer? Any time the word cancer is mentioned, stress is produced. And, anytime more studies and tests are done, which then ultimately return normal, unnecessary money, time, and energy are spent. In the US, this can occur 10-15% of the time (as noted from the American Cancer Society) in women from age 40-49years old, and this is from where the majority of the debate comes.

So, as a summary, this is the discussion I will have with my patients:

Let’s come to a reasonable, educated decision together.

We’ll decide together when the first one will be, which will probably be around age 40-45years old.

If there’s a strong family history of either breast or ovarian cancer, we will start earlier with the first mammogram. This might be at 35-40 years old.

Remember that the best screen is still a self-breast exam. Despite how wonderful our studies are in these modern times, educating patients to do their own monthly breast exams wins every time.

Starting at age 50years, it’s probably a good idea to start having mammograms every 1-2years”.

So, I haven’t changed my stance yet, and I don’t think I’ll change it for a while. 

Dr. Swiner

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