If you follow women’s health news, you’ve likely heard something about the American Cancer Society’s new—and controversial—guidelines that recommend the following:
• Women get their first mammogram at 45 instead of 40.
• Those 55 and older get screened every other year instead of annually.
• OB/GYNs do away with physical breast exams.
However, since some women’s health advocates, including the American Congress of Gynecology (ACOG), do not support these updated guidelines, what is a woman to do? We spoke with oncologist Dr. Theodora Ross, a leading researcher on cancer susceptibility genes and author of A Cancer in the Family, to help us make sense of the conflicting and confusing information.
First things first. Don’t panic. The Affordable Care Act ensures that anyone with Medicare can still get an annual mammogram starting at age 40, and most health-care companies will cover it as well. So you needn’t worry that your actual coverage will change—at least for now.
The new guidelines, according to Dr. Ross, aren’t designed to lessen your chances of prevention. Rather, they address the inherent flaws with the mammogram as a breast cancer screening tool. While mammograms are still a good and viable way to detect slow-growing tumors, they have proven to be largely ineffective at catching smaller, deadlier ones. Plus, for women with dense breasts, they frequently deliver false-negatives, which can provide false reassurance.
“Mammography is valuable for tumor types that are slow growing (similar to colon cancer that can be screened for every five to ten years). And similar to colon cancer, long periods between screenings work because of the slow growth,” says Dr. Ross. This rationale has led other countries to diminish mammogram testing; Switzerland has done away with it all together.
So what are the best options if you’re in the 40 to 45 range? Talk to your doctor and find out whether the test makes sense for you. “They should help you determine your risk, and the pros and cons of the mammogram. If you have fatty breasts and a strong family history of breast cancer, it is a reasonable screening tool for you,” Dr. Ross says. “And as a rule of thumb, we tell our patients to start imaging screening (mammography or MRI) ten years earlier than the first occurrence of breast cancer in the family.” Ditto if you’ve been diagnosed with a genetic mutation like BRCA1 (that Angelina Jolie had). However, even in those cases, mammography is still not the be-all and end-all, which is why mastectomy or tamoxifen is often the prescribed course of action if you carry a breast cancer gene. The hope is that one of the new tests in the pipeline (perhaps mammogram combined with some type of blood test) will be effective at catching and eradicating harmful pre-tumors and have similar success rates as a colonoscopy.
What about the changes for the 55 and older set? While the risk of breast cancer increases minimally as you age, data shows that screening every two years does not result in a difference in the detection of more advanced cancers. Again, the logic here is that two years is sufficient time to catch any slow-growing cancers that mammograms are most suitable to find.
As for the call to end physical breast exams at your annual OB/GYN appointment, Dr. Ross isn’t in agreement. “Given that a clinical breast exam takes a couple of minutes, and many cancers are found by experienced clinicians during a routine physical exam despite a ‘normal’ mammogram, I think it should still be a part of the exam. There is no harm to doing it and there is potential to find an abnormality.” The only downside, she says, is that not all doctors truly know how to perform a good breast exam, and there can be a lot of false-positives. Your doctor should be looking for a pea-size growth. Bottom line: If you have a good relationship with your gynecologist, ask for his or her thoughts on the matter, and don’t be afraid to get a second opinion.
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