Changes in Breast Cancer Screening

One of our community members was recently handed devastating news from her doctor: “You have breast cancer.”

Fortunately this middle-aged professional, we’ll call her “Susan,” was notified by her physician that the alert radiologist reviewing her mammogram suspected that the small lump might be cancerous and recommended further screening. She underwent a biopsy and was told that her cancer was in Stage 1, as it had traveled outside of its original site, but had not spread into the lymph nodes.

Susan recently had a lumpectomy and is about to undergo a three-week cycle of targeted radiation, and her prospects for a full recovery are excellent. She is one of more than 231,000 women who will be diagnosed with breast cancer this year, and she expects to be among most of the lucky ones who make a full recovery.

Ironically, however, her diagnosis and treatment come at a time when confusion about mammography screening is reaching a peak.

The standard recommendation, and one that the American Cancer Society has advocated for decades, was that every woman over 40 should have an annual mammogram. But that recommendation has been challenged recently by the U.S. Preventative Services Task Force (USPSTF), an independent panel of experts appointed by the federal Department of Health and Human Services to conduct research comparing expected outcomes under different screening scenarios.

Based on its findings, the USPSTF now recommends that women between the ages of 50 and 74 should get a mammogram less frequently, just every two years for women of “average risk.”  The task force also recommends that routine screenings should end by age 74 and that breast self-exams are of little value.

This task force came to its conclusion after looking at studies showing a reduction of breast cancer deaths associated with mammography that included screening intervals of 12 to 33 months. According to its findings, the evidence indicated that most of the benefits of screening are maintained when mammography is performed every two years as opposed to every single year, while the harms are reduced by nearly half.

Not all such organizations agree with these changes, and the current American Congress of Obstetricians and Gynecologists guidelines continue to recommend annual mammograms after age 40 without an upper age limit.

But as of last month, the American Cancer Society has adopted new recommendations similar to those of the USPSTF. The ACS now recommends that women with an average risk of breast cancer start having mammograms at the age of 45 and continue once a year until 54, then every other year for as long as they are healthy and likely to live another 10 years.

The ACS also said it no longer recommended clinical breast exams, in which doctors or nurses feel for lumps, for women of any age who have had no symptoms of abnormality in the breasts.

All of this may seem very confusing for many women, and rightly so. Many breast cancer physicians and experts have weighed in on these new guidelines, and I’d like to share what many of them are recommending.

Just because this new recommendation calls for fewer mammography screenings for average-risk women in their forties and following does not mean that these women women should not ever seek mammograms, these experts say.

Women can still request mammography screening and their doctors may prescribe it at any age, which fits in with both USPSTF and ACS guidelines, as both groups emphasize that mammogram screening should be based upon a decision between a patient and her clinician.

And certainly, if a patient has discovered a lump in her breast or has any concerns about her breast health, she can request mammography screening.

These new guidelines don’t apply to women who have known risk factors for breast cancer, such as those who have a close family member – a mother, sister, aunt, or grandmother – who have developed the disease. Those who have the BRCA mutation, a condition that elevates breast cancer risk for those affected with it, should be screened more regularly.

But a question that’s still not answered is whether the new guidelines will affect mammography coverage by insurance companies and other providers. This remains to be seen, but some experts expect that over time Medicare and private insurers will stop paying for annual mammogram screenings and screening for women in their 40s and those over 74.

As for paying for those mammograms, the USPSTF recommendations are influential in guiding policy, but the group doesn’t make specific recommendations about reimbursement.

Regardless of cost, any woman, regardless of her age or health status, should get a suspicious lump or other breast change checked out.

So perhaps the best advice for women of all ages is to be aware of their bodies, not to ignore any suspicious lumps or breast changes, and to discuss screening options with their clinician when situations of concern arise.

For those who are concerned about costs, be advised that county health departments in our region offer free breast and cervical screening for low income women who don’t have health insurance coverage.

Also, please know that we at the Northwest Georgia Healthcare Partnership have funds available to assist women with the costs of mammograms. There are certain criteria that must be met, but we will certainly help all those that we can. For more information, please give us a call at 706-272-6662.