October is Breast Cancer Awareness Month – get answers to some FAQs and latest screening guidelines below:
American Cancer Society
1. What is new with the guideline? How does it differ from previous ACS guidelines?
The biggest change to the guideline is that we now recommend that women at average risk for breast cancer start annual screening with mammograms at age 45, instead of age 40, which was the starting age in our previous guideline. Now, women ages 40 to 44 can choose to begin getting mammograms yearly if they want to.
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 annually.
The ACS is also no longer recommending a clinical breast exam (CBE) as a screening method for women in the U.S. Breast self-exam is also no longer recommended as an option for women of any age.
2. This guideline is for women at average risk for breast cancer, but how do I know if I am at average risk?
The best way to determine if you are at average or high risk for breast cancer is to talk with your health care provider about your family history and your personal medical history. In general, women at high risk for breast cancer include women with a family history of breast cancer in a first degree relative (mother, sister, or daughter), women with an inherited gene mutation, and women with a personal history of breast cancer. Learn more about breast cancer risk factors.
3. What exactly should a woman do at age 40? Should she get screened or not? How should she decide?
The risk of breast cancer is lower in women between the ages of 40 to 44. Still, some women will choose to accept the greater chance of a false-positive finding and the harms that could come from that (biopsy pain and anxiety, for instance) as a reasonable tradeoff for potentially finding cancer. The decision about whether to begin screening before age 45 is one that a woman should make with her health care provider.
4. Why can women choose to start screening every two years at age 55?
Although breast cancer is more common in older women, after menopause, breast cancer grows more slowly in most women, and is easier to detect early because the breasts are less dense. Since most women are post-menopausal by age 55, and because the evidence did not reveal a statistical advantage to annual screening in post-menopausal women, the guidelines committee concluded that women should move to screening every two years beginning at age 55. Still, the guideline says women may choose to continue screening every year after age 55 based on their preferences.
5. Why is a clinical breast exam (CBE) no longer recommended?
Clinical breast examination (CBE) is a physical exam done by a health professional. During the beginning of the mammography era, the combination of CBE and mammography was associated with a lower risk of dying from breast cancer, and CBE was shown to offer an independent contribution to breast cancer detection. Since then, as mammography has improved and women’s awareness and response to breast symptoms has increased, 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.
In addition, there was moderate evidence that doing CBE along with mammography increases the rate of false positives. Based on this information, the new guideline does not recommend CBE for U.S. women at any age.
6. What are the limitations of mammography and why is it important for women know about them?
Mammography is the best test we have at this time to find breast cancer early, but it has known limitations — it will find most, but not all, breast cancers. The Society supports informing women about the limitations of mammography so they will have reasonable expectations about its accuracy and usefulness. Studies show that informing women of the limitations of mammography before they have one decreases anxiety and improves later adherence with screening recommendations.
The accuracy of mammography improves as women age – thus, accuracy is slightly better for women in their 50s than women in their 40s and slightly better for women in their 60s than women in their 50s, and so on. However, a woman undergoing breast cancer screening needs to know that mammography at any age is not 100% accurate. Overall, mammography will detect about 85% of breast cancers.
Women also need to be prepared for the possibility of being called back for additional testing, even though most women who get further testing do not have breast cancer. On average, about 10% of women are recalled for further evaluation, including additional mammography and/or ultrasound, and sometimes a biopsy to determine if cancer is present.
Women also need to know that if their mammogram result is normal, but they detect a symptom months later before their next mammogram, they should see a doctor right away.
7. What about women who are at higher risk?
The Society has separate recommendations for women at increased risk for breast cancer, which are also being updated.
8. What about screening women in their 30s and younger? They get breast cancer, too. Doesn’t ACS care about that?
Cases of breast cancer in women who are in their 30s are rare, but that doesn’t make them any less tragic or important. The reason why none of the major guidelines recommend routine screening in this younger age group is because the evidence so far shows that the risk of harms such as false positive, additional procedures, and potential overdiagnosis outweighs the potential benefits, and routine screening for women in their 30s or younger doesn’t reduce deaths from cancer. The bottom line is that you can and should talk to your doctor about any concerns you have with your breast health at any age.