Breast Cancer Screening Guidelines

 

Are you confused about the conflicting recommendations for breast cancer screening? Here is a quick summary of the issues.

The US Preventive Services Task Force’s strongest recommendation was breast cancer screening every two years for low risk women aged 50-74. Starting earlier or continuing after 74 was an individual decision.

More recently the American Cancer Society (ACS) presented another set of recommendations for average risk women. Briefly, average risk means no personal risk of breast cancer, no genetic risk (e.g., BRCA), and no history of radiotherapy to the chest at a young age, no significant family history of breast cancer, no prior diagnosis of benign proliferative disease, and no significant mammographic breast density.

The new ACS recommendations are:

Annual screening, age 45-54.

Biennial screening at 55.

Younger women who desire screening should not be refused.

Screening should continue until the woman has less than 10 years of future life expectancy.

Physical exam of the breasts as a part of the annual exam and breast self-exam is not recommended. (Weak Recommendation).

 

The American College of OB-GYN responded by reaffirming their guidelines, which are annual screening for ages 40 and up, breast self-exam, and a medical breast exam as part of the annual exam for women aged 19 and up.

 

How do we make sense of these conflicting guidelines? Dr. Jennifer Harvey, Professor of Radiology at the University of Virginia discussed these conflicting recommendations in greater depth. Here is a summary of her opinion founded in her daily practice of breast cancer detection and prevention.

 

Breast cancer diagnosed in young women represents a more aggressive form of the disease, and these lives are worth saving. The down side of early screening is the increased risk of a false positive mammogram. If this is a major concern, consideration should be given to other imaging such as 3D tomography, which reduces false positives 15-30% and increases detection of invasive cancers 30-40%. Changing to screening every 2 years for low risk women is problematic because there is no accurate method to identify low and high risk women. For example, no risk assessment method accurately accounts for breast density.

Her recommendation is for women to start at age 40 with annual mammograms and continue as long as they are in good health and their life expectancy is 10 years or longer.