In a move that it sure to surprise and confuse many, the American Cancer Society has issued a new set of breast cancer screening guidelines that say most women should not begin getting yearly mammograms until the age of 45. That is a five-year difference from the old guidelines, which recommended that women begin breast cancer screening at age 40.
Dr. Richard C. Wender, the American Cancer Society’s Chief Cancer Control Officer, says the changes are the result of an external review of data that weighed the benefits versus the harm of screening with mammography.
“Since we last wrote a breast cancer screening guideline, there have been the publication of quite a number of new studies that inform us about the benefits and drawbacks of screening with mammography, so the American Cancer Society commissioned a detailed evidence review by an external expert group to review all of this new data which was then presented to our American Cancer Society guideline committee,” said Wender. “That committee then considered all of this evidence over a period of months, did the very difficult job of balancing the benefits and harms, and that’s what led to the change in the guidelines that we’re publishing now.”
The harm Dr. Wender is referring to is called a “false positive,” CNN reports. According to Dr. Otis Brawley, the American Cancer Society’s Chief Medical Officer, false positives are common in women under the age of 45, and, since doctors are not able to reliably detect harmful cancers from those that are harmless, they treat them all.
“If she starts screening at age 40, she increases the risk that she’ll need a breast cancer biopsy that turns out with the doctor saying ‘You don’t have cancer, so sorry we put you through all this,'” Brawley said.
Another major change in the guidelines is that breast exams, both self-exams and those provided by a doctor, are no longer recommended. According to the Cancer Society’s website, research does not show that self-exams provide a “clear benefit.” However, the organization does still encourage women to be familiar with their bodies and to know the normal look and feel of their breasts. They also recommend that any changes be reported to a health care provider immediately.
Once a woman turns 55, the new recommendation is that a mammogram is only needed once every other year. This change is due to research that has shown that, after menopause, cancerous tumors grow at a slower pace.
“This is one more set of recommendations that will be confusing to women and their primary care providers,” said Dr. Therese Bevers of MD Anderson Cancer Center. “Women are going to have questions and their providers may not know how to address them.”
Other critics say the American Cancer Society only reviewed cases in which the woman’s life was saved and did not consider those cases where screening led to early detection and prevented drastic treatments like chemotherapy and mastectomy’s, CNN reports.
“The American Cancer Society made the value judgment that screening is only worth it if it improves survival,” said Dr. Marisa Weiss, president of Breastcancer.org and a breast cancer survivor herself. “There’s an arrogance to that. Let women decide what’s meaningful to them.”
@nytimes That's a very dangerous precedent. I know someone who died of Breast Cancer in her mid thirties. Totally ridiculous.
— ULTM8SerenaWilliamsf (@ultm8swfans) October 20, 2015
@CNN Seriously, though, I lost my mom to breast cancer. I dont care what they say, GET CHECKED EARLY AND OFTEN PLEASE!
— Gabe Logan (@SirCuttsman) October 20, 2015
According to Dr. Wender, the debate surrounding the new guidelines is no surprise. “We know that debates will continue about the age to start mammography,” he said. However, Dr. Wender says the entire point of the new recommendations is to validate the effectiveness of mammography.
“The most important thing about our new guidelines is to validate that screening mammography is the most effective thing a woman can do to reduce her chances of dying of breast cancer,” Dr. Wender told NBC News.
One thing The American Cancer Society was sure to make clear is that these guidelines are only for women with an average risk for breast cancer. Those considered high risk need to begin earlier. The organization recommends talking to a medical provider for more guidance.