The American Cancer Society (ACS) recently published a new breast cancer screening guideline for women at average risk for developing breast cancer in the Journal of the American Medical Association (JAMA).
The biggest change to the guideline is that the ACS, now recommends that women at average risk for breast cancer start annual screening with mammograms at age 45, instead of at the previous age of 40. Now, women ages 40 to 44, can choose to begin getting mammograms yearly, if they prefer.
The ACS made this change because it said the evidence shows that the risk of cancer is lower for women ages 40-44 and the risk of harm from screenings (biopsies for false-positive findings, and over diagnosis) is somewhat higher. However, because the evidence shows some benefit from screening with mammography for women between 40 and 44 years, the guideline committee concluded that women in this age group should have the opportunity to begin screening based on their preferences and consideration of the tradeoffs. That balance of benefits-to-risks becomes more favorable at age 45, so annual screening is recommended starting at this age.
In addition, the new guideline says that women should transition to screening every two years starting at age 55, but can also choose to continue screening earlier and annually.
The ACS is also no longer recommending a clinical breast exam (CBE) as a screening method for women in the United States. That is because with the advancement of mammograms, the few studies that exist suggest that CBE contributes very little to early breast cancer detection in settings where mammography screening is available and awareness is high.
A CBE is a physical exam done by a healthcare provider as part of your regular medical check-up.
During a CBE, your provider should carefully feel your breasts and underarm for any changes or abnormalities (such as a lump). He/she should visually check your breasts while you are sitting up and physically examine your breasts while you are lying down.
If a CBE is not offered at your check-up and you would like one, ask your provider to perform one (or refer you to someone who can).
The ACE is also no longer recommending a breast self-exam as an option for women of any age. Again, the organization points out that evidence does not show that regular breast self-exams help reduce deaths from breast cancer. However, it is very important for women to be aware of how their breasts normally look and feel and to report any changes to a healthcare provider right away. This is especially important if a woman notices a breast change at some point in between her regular mammograms.
What is important to remember about the new guideline is that it targets women at average risk for breast cancer.
Only a small percentage of women are considered to be at very high risk for breast cancer.
For example, only about 5 to 10 percent of breast cancers in women are caused by inherited gene mutations. The best way to determine if you are at average or high risk for breast cancer is to talk with your healthcare provider about your family history and your personal medical history.
African American women however should be very careful about accepting the new guideline without question, because according to the U.S. Census Bureau, African Americans have the highest death rate and shortest survival of any racial and ethnic group in the nation for most cancers. Additionally, the bureau reports that breast cancer is the most commonly diagnosed cancer among African American women.
Breast cancer incidence rates are highest in non-Hispanic White women, followed by African American women and are lowest among Asian/Pacific Islander women. In contrast, breast cancer death rates are highest for African American women, followed by non-Hispanic White women.
Having a family member with breast cancer, in and of itself, does not mean a woman is at high risk for breast cancer. Family history is only one of many factors—some related to personal lifestyle choices, some not–that affect your overall risk.
Dr. Sylvia Morris, a Washington, D.C., based board certified internal medicine doctor who is a hospital consultant said the new guidelines make it even more important for a woman to have a personal relationship with a doctor.
She added that if a blood relative such as a mother, aunt, cousin or even sister has had breast or ovarian cancer, it is critical to have a conversation with your doctor about how to handle your own health risks.
Additionally, in terms of the new guidelines impacting your ability to get a mammogram, the ACS said that insurance coverage is usually linked to U.S. Preventive Services USPSTF (USPSTF) screening recommendations, not ACS guidelines. It’s too soon to tell what the long-term impact of the Society’s guidelines, or draft recommendations issued in April by the USPSTF, will be. If you have health coverage, the recommendation should not have any impact on your coverage this year. Your insurer may decide to change its coverage of routine mammograms in the future as a result of the new USPSTF guidelines or ACS guidelines. It’s also possible that your insurer will decide to keep its mammography coverage the same. The American Cancer Society strongly believes that women between the ages of 40-44 and women over the age of 55 should have access to annual mammograms without being charged a co-pay. To be sure, you can check with your health insurance company before scheduling the mammogram.
Also be aware that even with the new guidelines, a just released study published in the Oct. 6 of the medical journal BMJ found that a woman’s chance of surviving breast cancer are better the sooner the disease is caught. This means that if the cancer is caught when it is smaller survival is better. And Dr. Morris notes that is one of the problems Black women face. She said that quite often African Americans come in when the cancer has spread beyond localization and is much more developed.
