Stop Maligning Mammograms

New guidelines for breast checks issued, again

In a move that offers new guidelines and more confusion, the American Cancer Society has revised its recommendations on mammograms.

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The bombshell came Tuesday when the group announced that most women can start annual screenings at age 45 (versus age 40) and every other year after the age of 55.

The guidelines differ from those of a federal panel that recommended the general population of women wait until they are 50 to get their first mammogram. 

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Adding to the mix, the American Congress of Obstetricians and Gynecologists and the American College of Radiology recommend that annual mammograms begin at age 40.

Though the new ACS guidelines take into account the harms of false positives, the conflicting guidelines among medical groups are especially difficult for health care professionals when it comes to advising their patients.

“There are too many different bodies saying different things,” said Dr. Katherine Lee.

Lee, who spent 17 years at the Cleveland Clinic as a breast specialist, said she can understand why women don’t know what to do.

“Unfortunately, the women who are more likely to die from breast cancer are women in their 40s or younger.”

“Not only are the patients confused, but the physicians are confused,” she told LifeZette.

“Unfortunately, the women who are more likely to die from breast cancer are women in their 40s or younger,” Lee said.

That’s a haunting fact for 42-year-old Kelly Sanchez to hear. The New Mexico woman was so confused about whether she should get a mammogram that she figured she’d just wait until she was 50, despite a change she noticed in her breast.

It was only when her boyfriend insisted that she go for a screening that she did. The mammogram saved her life, she said. 

“I thank him every day for that,” she told LifeZette.

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Sanchez, an administrator for an accounting firm in Albuquerque, is almost fully recovered from a bilateral mastectomy and reconstruction she had in February. She knows that if she had followed the advice to wait until she was 45 or 50 for her first mammogram, cancer might be rampant in her body.

The negative and confusing debate about mammograms had given her a reason to put off the screening.

“That’s very, very scary,” she said.

Much of the uncertainty can be traced back to 2009, when screening recommendations became the focus of intense debate. The U.S. Preventive Services Task Force advised that women ages 50 to 74 were better off getting a mammogram every other year rather than annually.

In 2015, the USPSTF released new draft guidelines that reinforced what the task force had already recommended — that women in their 40s talk to their doctors about the benefits and potential harms before deciding to get screened.

That task force undid what was once a simple formula for women — turn 40, get a mammogram. The confusion over screening guidelines could gravely affect one segment of the population in particular.

“If you state to African-American women that they shouldn’t get mammograms until they’re in their 50s, you’ll miss a large number of breast cancers,” Lee said. “The highest number of African-American women who get breast cancer are actually in their 40s.”

Lee also noted that more aggressive breast cancer is found in women in their 40s. They are more likely to die from it since it’s more likely to have spread. Lee’s opinion about screening falls in line with what the American Cancer Society, the American Congress of Obstetricians and Gynecologists and the American College of Radiology recommend: Women should get annual mammograms beginning at 40.

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The USPSTF defends its position by acknowledging that some women in their 40s will benefit from mammography, while the majority will not. The federal panel does, however, make it clear that when a woman turns 40 she should talk to her doctor about the risks and benefits of a screening and make her own decision about whether to have a mammogram.

The American Cancer Society’s latest guidelines are published in the Journal of the American Medical Association. 

Sanchez, the New Mexican administrator, said she is concerned the confusion will just add to the excuses women make to put off a mammogram. As a breast cancer survivor, she’s concerned for other women in their 40s who may not have the support and incentive she did to get screened.

“You’ve got to take care of yourself,” she said.

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