Are You Confused About Mammogram Screening For Breast Cancer?

Breast cancer screening guidelines have become a bit confusing. There are quite a few organizations who have established guidelines but at present there are differing opinions.

The groups all agree that mammogram screening helps reduce deaths from breast cancer in women. However, the controversy involves the issue of when women should begin having screening mammogram and the frequency with which mammograms should be done. The experts from the various organizations have reviewed various published studies and have reached different conclusions. 

The fact is that screening mammograms can detect breast abnormalities. Clinical trials have demonstrated that for women in the 40s and 50s screening mammograms can reduce cancer deaths by as much as 15 to 29 percent. However, one study reported that despite early diagnosis resulting from screening mammograms, the number of women being diagnosed with advanced breast cancer hasn’t changed.  One conclusion that this suggested was that some women will be diagnosed with early breast cancer that would never have affected their health or lifespan.

The problem arises from the the fact that doctors cannot distinguish “dangerous” breast cancers that will eventually progress to advanced disease from those that will not become life-threatening. Therefore, annual mammograms remain the best alternative for detecting early disease and reducing the risk of death.

There is a legitimate concern that mammogram screening can lead to false positive results. A false positive occurs when an abnormality is detected that eventually proves to be benign—not cancer. A woman receiving a false positive result on screening mammogram may be asked to obtain additional mammogram images and other testing like an ultrasound. The problem of false positives is particularly difficult for younger women who may be more likely to receive a false positive results.

Presently, the decision on timing (and frequency) of mammogram screening is best decided based on each individual’s risk in  discussion with her health care provider.

Breast cancer screening guidelines

(Chart from www.FacingOurRisk.org “Mammogram Update by Lisa Schlager)

(To download a copy of this chart Comparison Breast Cancer Screening (1).)

• ACR, SBI, ACOG — annual mammogram starting at age 40, with no upper age limit 

• ACS — start at age 45, annual 45-54, biennial starting at 55, continue if life expectancy >10 years 

• Canada & most European countries start biennial screening at age 50 & stop at age 69 

• USPSTF, CDC, AAFP –every 2 years from age 50-74 

• USPSTF & ACS do not recommend Clinical Breast Exam (performed by healthcare provider) 


For clarification, I will provide the names of the above mentioned organizations.

ACR American College of Radiology

SBI Society of Breast Imaging

ACOG American College of Obstetrics and Gynecology

USPSTF US Prevention Service Task Force

AAFP American Academy of Family Physicians

ACS American Cancer Society

CDC Center for Disease Control

 

The density of the breast tissue as described on the mammogram can shape the decision as to what sort of mammogram study is preferred. Dense breast tissue is more difficult to assess on mammogram and the 3D mammogram  is better suited for women with dense breast tissue. The absolute guidelines have not been formulated for 3D mammograms. 3D mammograms are not offered everywhere and not all insurance companies cover the additional cost.

 

If you have a strong family history of breast cancer please review this with your provider to determine if you may be a candidate for genetic screening.

 

Also keep in mind risk reduction starts with lifestyle including avoiding smoking cigarettes and drinking alcohol.

Remaining physically active and eating a diet high in fresh vegetables, fruits and whole foods does decrease risk of breast cancer and important for heart health as well.