In 2015, the American Cancer Society (ACS) changed its breast cancer screening guideline. The revised recommendations remain controversial for, among other things, recommending less frequent mammograms for women 55 and older.
The New ACS Guideline
The revised ACS Guideline is merely a set of recommendations based on statistical analysis. It is the baseline strategy that the ACS feels is sufficient for early detection in women at average risk. The Guideline doesn’t necessarily preclude aggressive screening strategies needed to accommodate individual circumstances.
What Constitutes Average Risk for Breast Cancer?
Women are considered to be at average risk for breast cancer if they have:
- No prior history of breast cancer.
- No suspected or confirmed genetic mutation linked to breast cancer.
- No personal history of radiation therapy to the chest wall at a young age.
It’s important to understand that the new ACS Screening Guideline does NOT apply to women considered to be at higher risk.
Which Women Are at Higher Risk for Breast Cancer?
Women younger than age 45 are considered at higher risk if ANY of the above criteria are present.
Additionally, having any first-degree relative(s) – mother, sister, daughter – diagnosed with breast cancer before age 45, ovarian cancer at any age, or a male relative with breast cancer increase risk. A history of other medical problems or conditions involving breasts, as well as certain ethnic groups, are also associated with higher risk.
Why Are There Different Guidelines for Breast Cancer Screening?
Different guidelines or recommendations result from different analysis models and priorities used.
The ACS Guideline takes into consideration variables such as cost, false-positive and false-negative rates, and their resulting anxiety. It is a pragmatic model designed to maximize value while minimizing patient anxiety and discomfort.
By contrast, the American Society of Breast Surgeons (ASBrS) uses a model that prioritizes the number of years of life saved by early screening.
ASBrS recommends women with an average risk get yearly mammograms starting at age 40 (instead of 45), and does not support biennial mammograms in women 55 and over. In short, all women at average risk are encouraged to undergo yearly mammograms from age 40.
The advice you receive from a medical professional will be influenced by whichever guideline he or she is following.
We Strongly Support the ASBrS Stance
In our opinion, the aggressive nature of breast cancer makes the new ACS recommendations far too lax, potentially at the expense of valuable time. For all breast cancer patients, early diagnosis is the key to survival.
Ask your physician which guideline he or she is following and err on the side of a more aggressive screening approach.
Take an active role in the process – make sure you understand the risks and benefits before settling on any strategy. If you’re not satisfied with the answers you’re given, seek a second opinion.
(Please note: A separate post discussing mammograms themselves will be published soon.)
Photo by Annie Spratt on Unsplash