As baseball legend Yogi Berra once said, “It’s déjà vu all over again.”
Recently, more breast cancer screening recommendations have been released, which can often mean more confusion for women, particularly those in their 40s and 50s, about when to begin – and how often to get – routine mammograms.
If you’re confused after learning that the American College of Physicians recently published new guidelines suggesting that average-risk women aged 50 to 74 should get a mammogram once every two years, you’re not alone.
To help, experts from Henry Ford Cancer’s Breast Cancer Program provide answers to some of the most common questions they’ve been asked by patients about breast cancer screening.
What are the ACP’s new guideline recommendations for breast cancer screening?
- For average risk women aged 40 to 49, ACP suggests that women discuss getting a mammogram with their physician, citing that the potential harms outweigh the benefits in most women aged 40 to 49 years.
- For average risk women aged 50 to 74, ACP suggests women get a mammogram every other year.
- For average risk women aged 75 or older (or with a life expectancy of 10 years or less) clinicians should discontinue screening for breast cancer.
How do these new guidelines differ from others set by the American Cancer Society or the U.S. Preventative Services Task Force?
Unlike ACP, the American Cancer Society suggests that women should get annual mammograms starting at age 45 and continue annual screenings until age 54. For women 55 and up, ACS says women should have the option to continue annual screenings or get one every other year.
Like ACP, the USPSTF recommends that for women aged 40 to 49, getting a mammogram should be an individual decision. USPSTF also recommends biennial screening mammography for women aged 50 to 74.
What guidelines do you follow at Henry Ford?
All professional organizations support availability of screening mammography beginning at age 40 years, but differences between recommendations lie in whether a screening is mandated at a certain age or whether it should be a shared decision between the patient and the doctor. Henry Ford follows the guidelines outlined by the ACS.
“At Henry Ford, we begin discussing mammography at age 40, and participate in shared decision making as to whether to begin having mammograms,” says Diane George, D.O., who leads primary care services for Henry Ford Medical Group. “From age 45 to 54 we recommend yearly mammograms. From 55 onward we recommend every 1 to 2 years, with specific recommendations being based again on shared decision making (which includes risk factors and personal preference). We continue beyond 75 when there is a 10 year or more life expectancy.”
Protocols set out by other organizations are also taken into consideration to address the additional cancer control issues. These issues include 1) The growing population of women age 40-49, which means the volume of breast cancer patients in this young age range is increasing; and 2) Here in metro Detroit, the patient population features strong racial-ethnic diversity, including approximately 30 percent African Americans. African American women have a younger age distribution for breast cancer compared to White Americans, including approximately a two-fold higher rate of triple negative breast cancer (TNBC) in all age categories and early detection of TNBC is associated with improved outcome.
Could the new ACP recommendations impact insurance coverage for average-risk women who opt to begin regular mammograms at age 40?
No. Under the Affordable Care Act, annual screening mammography costs are covered for women beginning at age 40.
Is there a risk to beginning mammograms at age 50?
If the ACP guidelines are widely adopted, many doctors and cancer experts worry there will be an increase the number of younger women and African American women diagnosed with advance stages of breast cancer.
“The ACP claims that guidelines recommending that screening start at age 40 ignore ‘low incidence of breast cancer for women younger than 40 years,’ says Sabala Mandava, M.D., director of breast imaging at Henry Ford Health. “In fact, the majority of in situ cancer and nearly half of all breast cancers occur in women under 60. Also, the majority of life years lost to breast cancer occur in women diagnosed younger than age 60.
“Breast cancer incidence peaks in the late forties in non-white women and in the sixties in white women. The ACP approach may exacerbate racial disparities that already exist in breast cancer outcomes.”
Are the ACP guidelines a good fit for most women, particularly those with a family history of breast cancer at a young age?
Jessica Bensenhaver, M.D., director of the breast oncology program with Henry Ford Health, stresses that the ACP guidelines are ONLY intended for women at average risk for breast cancer.
“Women with hereditary predisposition for breast cancer, and women with prior breast biopsy results revealing that they are at increased risk for breast cancer should discuss intensified breast cancer screening strategies, such as breast MRI in addition to annual mammography, and they may consider initiating screening mammography younger than age 40,” Dr. Bensenhaver says.
What are the implications of the ACP guidelines for African American women?
“African American women are more likely to be diagnosed with breast cancer at younger ages, and are more likely to be diagnosed with aggressive forms of the disease such as triple negative breast cancer,” says Dr. Bensenhaver.
If ACP recommendations are widely adopted, she predicts that we will likely see an expansion of the breast cancer mortality gap that already exists between African American and white American women.
Are regular self-breast exams still important?
Women should continue to have a general awareness of any changes in their breast.
“Mammograms are not perfect, and so any breast cancer changes or findings warrant prompt attention regardless of when the most recent mammogram was performed,” says Dr. Bensenhaver.
Some examples of breast cancer danger signs: A new lump, a bloody nipple discharge, inflammatory changes in the skin of the breast, and flaky/inflamed nipple-areola skin.
Does early detection outweigh the risk of false-positive results?
While over-diagnosis, false positives and the associated anxiety are issues to be considered, many groups including the American College of Radiology, Society of Breast Imaging and even the ACS agree that over-diagnosis claims are inflated due to key methodological flaws in many studies.
“Early detection is our best weapon against breast cancer mortality and greatly outweighs the risk of false-positive results,” says Dr. Bensenhaver.
Still confused? Talk with your doctor.
If you have questions about what cancer screenings are right for you and when and how often you should have them done, having a conversation with your primary care doctor is the best place to start. He or she can discuss your personal cancer risk and any potential downsides to getting screened so that you can make the most informed decision about your health.
“Breast cancer screening, as a means of early cancer detection, is vital to successful treatment outcomes and we will continue recommending that patients begin discussing annual mammography screening at age 40,” says Dr. Bensenhaver.
To make an appointment with Henry Ford physician, visit henryford.com or call 1-800-HENRYFORD (436-7936). Need a primary care physician? Find one at henryford.com/findadoc.
Dr. Diane George is a family medicine specialist and Chief Medical Officer of Primary Care with Henry Ford Medical Group. She sees patients of all ages at Henry Ford Medical Center – Lakeside in Sterling Heights.
Dr. Jessica Bensenhaver leads Henry Ford Cancer’s Breast Cancer Program and is a surgical oncologist seeing patients at Henry Ford Hospital in Detroit, Henry Ford Wyandotte Hospital and at Henry Ford West Bloomfield Hospital.
Dr. Sabala Mandava is a board-certified radiologist and is the director of the division of breast imaging at Henry Ford Health.
