Changing Guidelines, Same Message: Get Screened

By: All for the Breast Editorial Team, May 10, 2016

When is the right time to get your first mammogram?

For women of average risk, the answer is…complicated. While all guidelines suggest beginning regular breast screenings at approximately middle age, recommendations can vary across a ten-year window, making it difficult to decide when to begin.

How do you know if you’re average risk? Breast cancer risk is calculated based on a variety of factors including age, race, and family history.

The most recent set of recommendations, put out by the U.S. Preventative Services Task Force (USPSTF), caused a stir in the medical community when it suggested women of average risk begin regular breast screenings at 50-74 years old. In comparison, the American Cancer Society (ACS) recommends that, “Women ages 40 to 44 should have the choice to start annual breast cancer screening with mammograms if they wish to do so.” ACS also advises women aged 45 to 54 to receive annual mammograms.

The youngest age recommendation comes from the American College of Radiology (ACR), which advises that women begin annual breast screenings at age 40.

As you can tell, the mixed messages make it confusing to know how to do the “right” thing.

Why isn’t there one recommended age to start getting screened?

Although all three organizations say to get regular mammograms, they disagree over the age at which the benefits of mammography outweigh the risks. For USPSTF, the psychological harm and anxiety of false positives, as well as the potential for over-treatment, outweigh the potential benefits of earlier screening. Whereas for the ACS and ACR, the potential for catching cancer at an earlier stage outweighs the potential upset of false positives.

According to Dr. Sheryl Gabram-Mendola, the Surgeon-in-Chief for Grady Health System and Director of the AVON Comprehensive Breast Center at Grady, another factor contributing to the varying guidelines is the concern of over-treating DCIS, or stage 0 breast cancer. Though there are women diagnosed with stage 0 breast cancer who do not need treatment, she argues that research has not yet provided a conclusive way to differentiate between the women who can do nothing and those who need treatment.

“We need more studies and more analysis,” said Dr. Gabram-Mendola. “I still believe it is more important that we adhere to the earlier skewing screening guidelines to save lives in our patients.” For her, the benefits outweigh the risks.

When getting a mammogram, it’s important to remember that false positives, while uncommon, do get diagnosed. According to ACR’s site Mammography Saves Lives, for every 1,000 women who have a screening mammogram: 100 are recalled to get more mammography or ultrasound images, 20 are recommended for a needle biopsy, and 5 are diagnosed with breast cancer. ACR added in a press release that the “short-term anxiety from test results is shown to have no lasting effects and does not outweigh the 35 percent reduction in breast cancer deaths and thousands of lives saved each year by mammography screening.” In other words, the short-term stress of coming in for additional testing doesn’t cause long-term harm.

Following the publication of the USPSTF guidelines, Dr. Gabram-Mendola and her colleagues conducted a follow-up study with support from Avon Foundation grants. The study showed that patient benefits when screened earlier included an earlier stage diagnosis, increased survival, and less costly treatments. Dr. Gabram-Mendola and the medical staff at Grady elected to continue adhering to the ACR guidelines and provide mammograms starting at age 40. However, other doctors follow the USPSTF guidelines.

Though the decision to get screened feels huge, the bottom line is that all women should be talking to their doctors to feel empowered and make a choice that they feel confident in. Through consultations, doctors can adapt the various recommendations to fit the individual based on their individual risk factors.

What guidelines should women adhere to?

“In the end it is a woman’s choice,” Dr. Gabram-Mendola concludes. “We just have to make sure the providers are well positioned and versed in being able to appropriately express the pros and cons of both arguments. I’m very much in favor of educating the providers just as much as the patients.”

Talking to doctors, learning more about the debate, and educating yourself on the issues is the best way to make the decision of when to get screened.
“Get educated, make an informed decision, and get comfortable with the decision that you are making,” adds Dr. Gabram-Mendola.

Know Your Body. Know Your Risks. Talk To Your Doctor.

Whether you are seeking a place to get screened or have been diagnosed with breast cancer, there are many resources available to help you. It’s important to learn about some of the common factors that can influence your personal breast cancer risk, and what actions you can take. Learn more at www.avonfoundation.org/checkyourself