American Cancer Society Issues New Breast Cancer Screening Guidelines

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American Cancer Society Issues New Breast Cancer Screening Guidelines

The American Cancer Society’s (ACS) new guidelines recommend that women start receiving mammograms at age 45 years instead of age 40 years. The American College of Obstetricians and Gynecologists and the U.S. Preventive Services Task Force now recommend that the starting ages for receiving regular mammograms are 40 and 50 years, respectively.

Mammograms have a high false positive rate, which means some women unnecessarily undergo multiple painful and time-consuming tests. False positive results are especially common for women younger than 45 years, because they have denser breasts and the tumors are more difficult to detect with imaging. “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,’” Dr Brawley said. “False positives are a huge deal. These women are so frightened and inconvenienced they swear off mammography for the rest of their lives.”

The American Cancer Society emphasized that women in their early 40s should still be able to receive mammograms if they choose, as long as they understand that the risks can include false positive results, or detection of a small tumor that may result in unnecessary treatment. According to a review in the New England Journal of Medicine, a Canadian study of 44,925 women who were screened for breast cancer revealed that a total of 106 of these women received unnecessary breast cancer treatment.

Manual Exams

The new guidelines also state that manual breast exams are not necessary. According to the ACS, a literature review showed that manual breast exams are not effective. “The chance that you’re going to find a cancer and save a life is actually very small,” said Otis W. Brawley, MD, ACS Chief Medical Officer.

However, advocates for women with breast cancer claim that there is no reason to discontinue manual exams. “It’s a free and added way of knowing whether or not a lump is there,” said Leigh Hurst, founder of the Feel Your Boobies Foundation.

Potential Flaws

Some advocates for women claim that the ACS mostly reviewed studies of film mammography, which has largely been replaced by digital mammography in the United States. Digital mammograms produce clearer images and have a lower false positive rate than film mammograms. “It’s like standard versus HD TV,” said Therese T. Bevens, MD, Chair of the National Comprehensive Cancer Network’s guidelines panel for breast cancer screening and diagnosis, and Medical Director, Cancer Prevention Center, MD Anderson Cancer Center.

Critics also point out that the ACS only considered whether screening saved a woman’s life, and not whether screening detected cancer early. “The American Cancer Society made the value judgment that screening is only worth it if improves survival,” said Marisa C. Weiss, MD, a breast cancer survivor and President of “There’s an arrogance to that. Let women decide what’s meaningful to them.”

Other Factors to Consider

The new ACS guidelines also state that women older than 55 years of age are able to receive a mammogram every other year, because postmenopausal women tend to develop breast cancer more slowly than premenopausal women.

Insurance companies will also influence the age at which women receive mammograms. In 2009, insurance companies continued to pay for mammograms for women ages 40 and above even though the federal government’s task force recommended mammograms for women ages 50 and above. “(Insurance) plans will certainly take these updated recommendations into account when evaluating their coverage policies,” according to Clare Krusing, a spokeswoman for America’s Health Insurance Plans.

According to the ACS, women with a family history or who carry genes that predispose them to breast cancer may need to receive mammograms at a younger age and more frequently. “Our biggest concern is that this will create a lot of potential havoc in the day-to-day practice of caring for women,” said Christopher M. Zahn, MD, Vice President of Practice Activities for the American College of Obstetricians and Gynecologists.


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