New guidelines for mammograms released Tuesday by the American Cancer Society represent a significant step back from the aggressive early and universal screenings the country began 18 years ago.
The changes — which include raising the age that a woman of average risk begins regular screening from 40 to 45 — are a recognition of the growing concern that the benefits of mammograms may have been oversold, as well as the anxiety and needless treatments caused by overdiagnosis and false positives from the tests.
Richard Wender, a member of the breast cancer guideline panel and a former president of the ACS, said the new recommendations confirm that mammography is the most important thing a woman can do to reduce her chance of dying of breast cancer but that they provide a more “personalized and tailored approach.”
“Over the past couple of years, there has been so much confusion that some women and some clinicians have really lost confidence in mammography. We hope this extraordinary and thorough review will calm that worry,” Wender said.
The more conservative approach outlined by the ACS calls for women starting yearly screening at age 45 and then transitioning to screening every two years starting at age 55 — which the panel used as a surrogate for menopause. It also recommended that doctors stop screening women with a life expectancy of less than 10 years based on the idea that they will likely die with the cancer but not from it. The recommendations are only for women who don’t have specific risk factors for breast cancer such as the BRCA1 and BRCA2 genetic mutations or a family history of the disease.
On Tuesday, breast cancer patient groups expressed alarm that the new guidelines — while not binding to doctors, hospitals or insurance companies — may lead too many women to skip life-saving screenings and provide an excuse for health plans to stop covering them as much as they currently do.
“We are worried about the message and confusion to the public when they see these new guidelines. The cutback on screening is falsely reassuring,” said Marisa C. Weiss, an M.D. who is the founder and president of .
Judy Salerno, president and CEO of Susan G. Komen, said she’s “concerned that they have the potential to lead to reduced accessibility to and coverage for health screenings from both private and public insurers.”
The ACS’s updates come at a time when cancer experts are rethinking the very definition of cancer. Thanks to advances in genetic testing, blood-based markers and digital imaging, cancer is being diagnosed earlier than ever, and there’s a radical new recognition that there are subset tumors that are detected but may never grow enough to be harmful.
Mammograms, X-rays of the breast that have been used for more than a century to pinpoint irregularities in the tissue, are credited with saving many millions of lives by catching cancers at their earliest stages. Breast cancer is one of the leading killers of women in the United States, with approximately 225,000 diagnosed each year and 41,000 dying from the disease. In part because of the ubiquitous pink ribbon-themed races, T-shirts and stuffed animals of breast cancer fundraisers and in part because of stories like Angelina Jolie’s, many women have come to believe that the more screening and the more treatment the better.
But a number of new studies have questioned this idea.
In July, for example, a reanalysis of data from a pivotal paper based on women in the 1960s and ’70s in Sweden showed that screening could reduce deaths around 10 percent — rather than the 20 percent to 25 percent originally claimed. And in August, a study in JAMA Oncology found that the overall risk of dying after being diagnosed with so-called stage 0 or ductal carcinoma in situ cancer was 3.3 percent over two decades and that pursuing treatment beyond a lumpectomy did not affect survival.
The U.S. Preventive Services Task Force, an independent panel of experts whose members are appointed by the federal government, reaffirmed their view this April that women between ages 50 and 74 get routine screening once every two years. The American College of Obstetricians and Gynecologists still recommends that regular screenings begin at age 40.
Breast cancer risk
Part of the reason for the changes in the guidelines is that women’s risk of breast cancer increases as they age.
Age range Percent risk over 5 yearsYounger than 340.2%35-390.340-440.645-490.9 (1.1?)50-541.155-591.360-641.665-79270-742.1
The Washington Post
