The American Cancer Society's (ACS) updated guidelines on breast cancer screening pushed back the mammogram start age to 45 years old. In addition, the society suggests that women can 'skip' the manual breast checks offered by doctors on a routine basis. What happened to the benefits of regular checkups and early detection? After an in-depth review of medical studies, the cancer society found that these 'measures' are not very successful.
"The chance that you're going to find a cancer and save a life is actually very small," said Dr. Otis Brawley, ACS' chief medical officer.
Adding to the confusion are the varying ages recommended by three key groups for kicking off regular mammograms: American College of Obstetricians and Gynecologists said 40 years old, the ACS recommended 45 years old and lastly, the U.S. Preventive Services Task Force said 50 years old. The difference lies in the way each group handles the pros and cons of mammograms, which can also cause harm in its goal to save lives.
In a gist, here's what ACS is recommending now for women with average risk of developing breast cancer:
- (Qualified Recommended) Women can opt to start annual mammogram screenings between 40 and 44 years old.
- (Strong Recommendation) Women are strongly recommended to have regular screenings starting 45 years old.
- (Qualified Recommended) Women should be screened annually between ages 45 and 54 years old.
- (Qualified Recommendation) Women can be screened every other year or maintain the opportunity to be screened annually starting 55 years old.
- (Qualified Recommendation) As long as overall health is good and life expectancy exceeds 10 years, women are advised to undergo regular mammograms.
- ACS deems self-exams 'no longer necessary' and suggests doctors to cease offering manual breast exams.
Resistance from the Medical Community
ACS highlighted the dangers of false-positive mammograms results which is high for women below 45 years old. Younger women have denser breasts, therefore it makes tumors harder to spot on the images. Brawley expressed that false-positive results have big impacts on women who sometimes get so terrified they end up not getting mammography in succeeding years.
Brawley also pointed to the mammogram's potential of catching a 'very small breast cancer' that could fail to progress or could disappear on its own. However, doctors could not always distinguish the harmful ones from the harmless ones with potential regression. This leads doctors to treat all breast cancers they find, which means women could be getting harmful treatments and its side effects such as radiation when it is possible that the tumor won't even progress to a stage that it could cause health problems. Case in point was a 2014 Canadian study which revealed 106 breast cancer patients out of 44,925 were treated 'unnecessarily'.
However, some doctors are looking at a different angle.
Radiologist Dr. Lora Barke is the medical director at Invision Sally Jobe, a breast imaging specialty center. She expressed that breast cancer is one of the few medical conditions wherein patients can select prevention when detected early.
"It's one of the cancers we can screen for so it's such a shame people aren't taking advantage of that screening tool," said Barke who explained that the revised guidelines stemmed from the fact that mammograms could create 'false positives'.
Another doctor shared the same perspective with Barke. Dr. Therese Bevers, Cancer Prevention Center medical director at the University of Texas MD Anderson Cancer Center said the harm linked to false-positive reading are exaggerated. She expressed that while mammograms are time-consuming and the week spent waiting for the results is 'not fun', women who take the 'extra effort' are reassured that they don't have cancer.
Medical experts criticized the new guidelines by stating that the studies reviewed by ACS were mostly film mammography. In the U.S., this was entirely replaced by a digital mammography, which gives a clearer image of the scanned breasts with lower false-positive risks. The critics also said that the ACS only focused on whether screenings saved lives and not on the more important picture: whether screenings were able to detect cancer at an early age so that patients can avoid the drastic treatments like mastectomy and chemotherapy.
"The American Cancer Society made the value judgment that screening is only worth it if improves survival. There's an arrogance to that. Let women decide what's meaningful to them," said breast cancer survivor Dr. Marisa Weiss, president of Breastcancer.org.
Photo: Joshua Smith | Flickr
