October is national breast cancer awareness month and October 17 is mammography day.
If you are confused about the screening recommendations for a mammogram, you are not the only one – so are many doctors. A few months ago, the American Cancer Society updated its recommendations for breast cancer screening, hoping to iron out the controversies and make mammography the mainstay of breast cancer screening.
The lifetime risk of a women developing breast cancer is one in eight. Over the past two decades studies have shown that a mammogram can reduce a women’s mortality risk by twenty-four percent on average and mammography has become the most reliable and available early detection method. Doctors were optimistic when they saw a decline in the breast cancer mortality rate over fourteen years, coupled with a rise in the mammography rate among women over forty.
Things were going well until two years ago when a Danish study published in a prestigious medical journal, Lancet, challenged the benefits of mammography among all women. The authors reviewed previous studies and concluded that these studies had some flaws and biases, which resulted in no net mortality benefit from mammography.
Gasp! The entire scientific and breast cancer prevention advocacy community was speechless. So multiple analysis and reanalysis – point and counterpoints – were presented in journal articles. No study data was left unturned.
In final, researchers concluded that mammography was indeed beneficial and reduced the mortality rate of breast cancer especially among women fifty years and older. It was still unclear for the other age groups.
Yet, the damage was already done. A doubt was created in the public’s mind and women who were looking for an excuse to avoid a somewhat uncomfortable and mildly painful procedure now found a crutch – nonetheless – a scientific one.
Through all of this, the American Cancer Society and ten other government, private and advocacy groups and medical societies such as the National Cancer Institute and Susan G. Komen Breast Cancer Foundation remained steadfast in their recommendation for mammograms for women fifty to sixty-nine years old.
For women ages forty to forty-nine there is a soft debate about the recommendation for a mammogram. Yet the majority of the organizations, including the American Cancer Society, still recommend annual or biannual mammograms for this group.
For the elderly (over the age of seventy), American Cancer Society is taking a new stance in their guidelines for mammography. If elderly patients have a chronic or serious illness or short life expectancy, then it is reasonable to forgo a mammogram.
So, in brief, here are the American Cancer Society’s 2003 guidelines:
- Women who are thirty to forty years old should get a clinical breast exam every three years by their provider plus a baseline mammogram.
- Women over forty should get an annual mammogram.
- Women at high risk (women with previous abnormal biopsy, history of breast cancer and family history of breast cancer,) should start screening at age thirty and possibly consider more frequent screenings (every six months) and to consider other adjunct modalities such as ultrasound and/or MRI (Magnetic Resonance Imaging).
As for other recommendations, self-breast examinations are now optional. Research has not shown these monthly exams to be more beneficial than simple self-awareness. However, women should promptly report any changes in their breasts to their doctor. The use of MRI and ultrasound is encouraged especially among women at high risk and those who have significant breast density.
Let there be no doubt, for now and for the near future, mammography is the gold standard for breast cancer prevention. It saves lives. The rest is details.