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ACS Mammography Guidelines

Posted 10/21/2015

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  Once again, this subject hits the proverbial fan. The American Cancer Society, ACS, yesterday joined a long list of cancer organizations that have changed their guidelines re mammography/breast cancer screening. The trend is towards starting later and having mammograms less frequently. This was announced yesterday, and, by noon, I had already heard from at least a dozen women who were furious. One asked who is going to lead the "Tell the Truth, ACS" campaign.

  Here is what ACS said: American Cancer Society Guidelines for the Early Detection of Cancer
The American Cancer Society recommends these cancer screening guidelines for most adults. Screening tests are used to find cancer before a person has any symptoms.

Visit our website, www.cancer.org, or call our toll-free number, 1-800-227-2345, to get more details on our cancer screening guidelines or to learn more about what you can do to help reduce your risk of getting cancer.

Breast cancer
•Women ages 40 to 44 should have the choice to start annual breast cancer screening with mammograms (x-rays of the breast) if they wish to do so. 
•Women age 45 to 54 should get mammograms every year. 
•Women 55 and older should switch to mammograms every 2 years, or can continue yearly screening.
•Screening should continue as long as a woman is in good health and is expected to live 10 more years or longer. 
•All women should be familiar with the known benefits, limitations, and potential harms linked to breast cancer screening. They also should know how their breasts normally look and feel and report any breast changes to a health care provider right away. 
Some women – because of their family history, a genetic tendency, or certain other factors – should be screened with MRIs along with mammograms. (The number of women who fall into this category is very small.) Talk with a health care provider about your risk for breast cancer and the best screening plan for you

http://www.cancer.org/healthy/findcancerearly/cancerscreeningguidelines/american-cancer-society-guidelines-for-the-early-detection-of-cancer


It is important to remember that any guidelines are based on solid data, studies that have looked carefully at large populations and the benefits of particular screenings or tests. Of course there are individuals, younger women, whose breast cancers were found "early" on mammograms. There will always be exceptions, and women who have had this experience are likely to be very passionate about the importance of early and annual screening. The facts, however, are that mammograms are not so good at detecting cancers in pre-menopausal women whose breasts are dense. The explanation given is usually something like: "It's like looking for a polar bear in a snow storm." For older women, mammograms work better. Using myself as an example (and realizing that I am an "n" of one), my first cancer, when I was 44, was never seen on mammogram--even when I and my doctor could palpate it. My second cancer, when I was 56, was seen on an annual mammogram.

The more surprising part of the ACS recommendations is the suggestion that clinical breast exams are not necessary. This includes BSE (breast self exam) that is much less strongly pushed than it used to be.Again, it's the data speaking. When you look at large studies of large numbers of women, very few women found a breast lump during a monthly BSE. Most self-discovered lumps were found spontaneously in the shower, during love-making, while getting dressed, etc. 

The Young Survivors Coalition, YSC, is a terrific group with a commitment to younger women with breast cancer. Their response to the ACS announcement concurred with the recommendations, but emphasized the need for better screening tools for younger women. Here is a quote and the link to read more:

Screening Mammography Recommendation Changes:
The mammography screening debate is complicated, and a more thorough discussion of the issues and research can be found in the Background & Support section below. Screening mammography for women over 40 or 50 years of age does not directly impact the young breast cancer survivors served by Young Survival Coalition (YSC). YSC interprets the change in ACS guidelines as a public admission that there is no benefit to screening mammography between the ages of 40-44. Not only is there no benefit, the risks outweigh the benefits such that a change in recommendation is warranted.
YSC concurs. It is not YSC’s position that screening mammography should be completely eliminated. We do believe, however, that women should be counseled about the risks and benefits of screening mammography, in consultation with their doctors and make an individual decision that is best for them. It is a long-held YSC belief that better tools are urgently needed to diagnose, detect and monitor for breast cancer in younger women.

https://www.youngsurvival.org/sites/default/files/docs/YSC_Response_ACS_MammoCBE_Guidelines_F.pdf

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