Are the new ACS breast cancer screening guidelines right for me?

October 30, 2015 | by Valerie Howard

This week, the American Cancer Society (ACS) issued revised breast cancer screening guidelines that, for many women, may be raising more questions than answers.

The new guidelines are suggested recommendations by the American Cancer Society for women of “average risk” (e.g., with no personal or family history of breast cancer). In summary, they include:

  • Starting at age 45, women should undergo regular screening mammography.
  • Women 45 to 54 years of age should be screened annually.
  • Women 55 years and older should transition to biennial screening, but should have the opportunity to continue screening annually.
  • Women should have the opportunity to begin annual screening between 40 and 44 years of age.
  • Women should continue annual mammography screening as long as their overall health is good and they have a life expectancy of at least 10 years.
  • Clinical breast examinations are not recommended among average-risk women at any age.

While the new recommendations do encourage women to consult their physicians to determine the best approach, the issue of mammograms — who should be getting them, and how often — can still be largely confusing.

To help provide some guidance and clarification on the issue, two City of Hope breast cancer specialists, George Somlo, M.D., a professor of breast oncology and staff physician, and Veronica Jones, M.D., an assistant clinical professor of surgical oncology and breast surgeon, answer five questions women are likely to have.

  1. If the American Cancer Society thinks I should be doing fewer mammograms, does this mean mammography doesn’t really work when it comes to detecting breast cancer?

    Dr. Somlo: While standard mammography is not sufficiently specific or sensitive — and as a technology is evolving to 2-D and now 3-D imaging/tomosynthesis — it is still an effective first screening tool.

    Dr. Jones: In order to yield the highest benefit from mammograms, we need to tailor who is getting them and when. This decision should be made after a conversation with your doctor, and based on your genetic and personal history.
     
  2. What if I have a family history of breast cancer, should I stick with these guidelines?

    Dr. Somlo: Absolutely not. Patients with strong family history, a known genetic predisposition to breast cancer (such as BRCA1 or BRCA2 carriers and those with other known genetic risk factors), should follow well-defined guidelines with the help of expert physicians for high-risk screening, inclusive of mammogram and other modalities obtained at an earlier age.

    Dr. Jones: It is important to consult your doctor and determine a plan that is right for you. I can’t emphasize this enough: there is no such thing as a one-size-fits-all approach, especially if you have a family history of breast cancer.
     
  3. What if I have “dense” breasts? Does this change anything?

    Dr. Somlo: In general, women who are younger or who are premenopausal are more likely to have denser breast tissue. Dense breast tissue in and of itself wouldn’t prompt a change in screening. Check with your doctor if you have a concern, to determine the best approach.

    Dr. Jones: Dense breast tissue may not change how frequently you are screened, but it may change the type of screening you get. Imaging technology is constantly changing and evolving. Three-D mammograms, for instance, have been really helpful to women with dense breasts.
     
  4. Should I still be doing self-examinations?

    Dr. Somlo: I can’t think of a cheaper, easier screening test for women. I would not disregard the importance of self-examinations in breast cancer prevention, even though self-examination is not very sensitive.
     
  5. How important are these guidelines, overall?

    Dr. Somlo: These guidelines are intended for the general female population and should be taken as such. In no way would these guidelines change my recommendations for individual patients, particularly high-risk patients. I advise women to follow their instincts and concerns and if they find something concerning during a self-exam, to speak with a doctor to determine the best approach.

    Dr. Jones: Women should talk about these guidelines with their physicians and come up with a plan that works for them.
 
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Learn more about breast cancer treatment and research at City of Hope.
 
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